Provider Demographics
NPI:1417731837
Name:REA, EMILY ELIZABETH (LM, CPM)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:REA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:838 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3705
Mailing Address - Country:US
Mailing Address - Phone:707-391-6172
Mailing Address - Fax:
Practice Address - Street 1:838 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3705
Practice Address - Country:US
Practice Address - Phone:707-391-6172
Practice Address - Fax:707-397-1068
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife