MEDICARE: WILD WOMB MIDWIFERY, PLLC

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	:	1336855733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD WOMB MIDWIFERY, PLLC

Provider Business Mailing Address
First Line	:	2314 N CHERRY ST STE 200
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1152
Country	:	US
Telephone Number	:	509-850-0527
Fax Number	:	509-505-6277

Provider Business Practice Location Address
First Line	:	2314 N CHERRY ST STE 200
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1152
Country	:	US
Telephone Number	:	509-850-0527
Fax Number	:	509-505-6277

Authorized Official
Title or Position	:	CO-OWNER/MIDWIFE
Name	:	BRIANA HUISMAN
Credential	:	LM
Telephone Number	:	509-703-3644

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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