Provider Demographics
NPI:1063040491
Name:TERRALUMINA, RENEE A (LM, CPM)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:TERRALUMINA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 JACKSON HWY
Mailing Address - Street 2:CHEHALIS
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-623-1035
Mailing Address - Fax:360-633-2993
Practice Address - Street 1:2175 JACKSON HWY
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-623-1035
Practice Address - Fax:360-633-2993
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61046337176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty