Provider Demographics
NPI:1710031299
Name:COYOTE, BETH (LM, CPM)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:COYOTE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 S FERDINAND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1739
Mailing Address - Country:US
Mailing Address - Phone:206-721-0142
Mailing Address - Fax:
Practice Address - Street 1:222 10TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5720
Practice Address - Country:US
Practice Address - Phone:206-861-8300
Practice Address - Fax:206-861-8305
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000064176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7019292Medicaid