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General NPI Number Information
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NPI Number | 1972974798
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Entity Type | Organization
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Legal Business Name | EASTSIDE MIDWIVES
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 13128 TOTEM LAKE BLVD NE SUITE 101
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City | KIRKLAND
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State | WA
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Zip | 98034-2953
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Country | US
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Telephone | 425-823-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 13128 TOTEM LAKE BLVD NE
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City | KIRKLAND
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State | WA
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Zip | 98034-2953
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Country | US
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Telephone | 425-823-1919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEIKE HORNSBY
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Credential | LM, CPM
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Telephone | 425-823-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | MW60569358
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License Number State | WA
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