Provider Demographics
NPI:1063040517
Name:CHI, SOTHYRY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SOTHYRY
Middle Name:
Last Name:CHI
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 1:3663 COLLEGE ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2303
Mailing Address - Country:US
Mailing Address - Phone:360-481-0105
Mailing Address - Fax:
Practice Address - Street 1:3663 COLLEGE ST SE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2303
Practice Address - Country:US
Practice Address - Phone:360-481-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMIDW.MW.61055715176B00000X
WA61055715176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife