Provider Demographics
NPI:1376185538
Name:WILDER MIDWIFERY, LLC
Entity Type:Organization
Organization Name:WILDER MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:VINING
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:405-596-7326
Mailing Address - Street 1:3262 MAYFIELD PL N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-6034
Mailing Address - Country:US
Mailing Address - Phone:405-596-7326
Mailing Address - Fax:
Practice Address - Street 1:405 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6219
Practice Address - Country:US
Practice Address - Phone:405-596-7326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty