MEDICARE: MARY CATHERINE GREEN LM, 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	1194868844	WA

General Provider Information

NPI Number	:	1194868844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CATHERINE GREEN LM, CPM

Provider Business Mailing Address
First Line	:	200 3RD ST
Second Line	:
City	:	LYNDEN
State	:	WA
Zip	:	98264-1411
Country	:	US
Telephone Number	:	360-510-0188
Fax Number	:	844-411-7474

Provider Business Practice Location Address
First Line	:	200 3RD ST
Second Line	:
City	:	LYNDEN
State	:	WA
Zip	:	98264-1411
Country	:	US
Telephone Number	:	360-510-0188
Fax Number	:	844-411-7474

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/15/2025

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