MEDICARE: MICAH DIELLE READ BOWER

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	374J00000X	Doula

General Provider Information

NPI Number	:	1053046318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAH DIELLE READ BOWER

Provider Business Mailing Address
First Line	:	1113 RAINIER CIR
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-4157
Country	:	US
Telephone Number	:	303-715-8628
Fax Number	:

Provider Business Practice Location Address
First Line	:	1113 RAINIER CIR
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-4157
Country	:	US
Telephone Number	:	303-715-8628
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	08/01/2022

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