Provider Demographics
NPI:1578115515
Name:NORTHSHORE MIDWIVES & LACTATION CONSULTING, LLC
Entity Type:Organization
Organization Name:NORTHSHORE MIDWIVES & LACTATION CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LM, CPM, IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-286-0466
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-2045
Mailing Address - Country:US
Mailing Address - Phone:425-286-0466
Mailing Address - Fax:425-341-9661
Practice Address - Street 1:18208 66TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-286-0466
Practice Address - Fax:425-341-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8495921Medicaid