Provider Demographics
NPI:1467897140
Name:FOOTHILLS MIDWIFERY
Entity Type:Organization
Organization Name:FOOTHILLS MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:LM CPM
Authorized Official - Phone:206-227-2211
Mailing Address - Street 1:1913 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3303
Mailing Address - Country:US
Mailing Address - Phone:206-227-2211
Mailing Address - Fax:206-430-6227
Practice Address - Street 1:1751 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3507
Practice Address - Country:US
Practice Address - Phone:206-227-2211
Practice Address - Fax:206-430-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60325156176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty