Provider Demographics
NPI:1518293505
Name:MOTHERSEED MIDWIFERY, LLC
Entity Type:Organization
Organization Name:MOTHERSEED MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:TONKIN SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:503-312-9461
Mailing Address - Street 1:19295 SW HENNIG ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19295 SW HENNIG ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2412
Practice Address - Country:US
Practice Address - Phone:503-709-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10132453176B00000X
08030019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty