MEDICARE: FOOTHILLS MIDWIFERY

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	MW60325156	WA

General Provider Information

NPI Number	:	1467897140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS MIDWIFERY

Provider Business Mailing Address
First Line	:	1913 WILSON AVE
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3303
Country	:	US
Telephone Number	:	206-227-2211
Fax Number	:	206-430-6227

Provider Business Practice Location Address
First Line	:	1751 COLE ST
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3507
Country	:	US
Telephone Number	:	206-227-2211
Fax Number	:	206-430-6227

Authorized Official
Title or Position	:	MIDWIFE/OWNER
Name	:	TERAH LARA
Credential	:	LM CPM
Telephone Number	:	206-227-2211

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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Directions to “FOOTHILLS MIDWIFERY ” Practice Location

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