Provider Demographics
NPI:1407009160
Name:METHOW MIDWIFERY AND WOMENS HEALTH PLLC
Entity Type:Organization
Organization Name:METHOW MIDWIFERY AND WOMENS HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:509-341-4256
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0503
Mailing Address - Country:US
Mailing Address - Phone:509-341-4256
Mailing Address - Fax:253-231-5763
Practice Address - Street 1:214 N GLOVER ST
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856-0503
Practice Address - Country:US
Practice Address - Phone:509-341-4256
Practice Address - Fax:253-231-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60035365363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty