Provider Demographics
NPI:1790554087
Name:WONDERFULLY MADE MIDWIFERY LLC
Entity Type:Organization
Organization Name:WONDERFULLY MADE MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VONGREY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:360-391-5988
Mailing Address - Street 1:806 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7808
Mailing Address - Country:US
Mailing Address - Phone:360-391-5988
Mailing Address - Fax:360-639-6331
Practice Address - Street 1:902 NE CENTER ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3466
Practice Address - Country:US
Practice Address - Phone:360-391-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty