MEDICARE: MS. RHONDA LEE GRANTHAM CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1023303039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA LEE GRANTHAM CPM

Provider Business Mailing Address
First Line	:	1910 4TH AVE E
Second Line	:	PMB # 51
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4632
Country	:	US
Telephone Number	:	360-742-4764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 MARION ST NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4436
Country	:	US
Telephone Number	:	360-742-4764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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