MEDICARE: OLYMPIA HELENA-ROSE MCCUTCHAN 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	268	CA

General Provider Information

NPI Number	:	1699077339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLYMPIA HELENA-ROSE MCCUTCHAN LM, CPM

Provider Business Mailing Address
First Line	:	PO BOX 101
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525-0101
Country	:	US
Telephone Number	:	707-223-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 F STREET
Second Line	:
City	:	BLUE LAKE
State	:	CA
Zip	:	95525
Country	:	US
Telephone Number	:	707-223-5322
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/19/2013

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