Provider Demographics
NPI:1821180746
Name:WHIDBEY WOMEN'S HEALTH
Entity Type:Organization
Organization Name:WHIDBEY WOMEN'S HEALTH
Other - Org Name:M LUCIE RIEDERER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LUCIE
Authorized Official - Last Name:RIEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-678-8308
Mailing Address - Street 1:201 BIRCH
Mailing Address - Street 2:PO BOX 1470
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-1470
Mailing Address - Country:US
Mailing Address - Phone:360-678-8308
Mailing Address - Fax:360-678-5604
Practice Address - Street 1:201 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-1470
Practice Address - Country:US
Practice Address - Phone:360-678-8308
Practice Address - Fax:360-678-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB06366OtherMEDICARE GROUP #
WA7093016Medicaid
WA7093016Medicaid
WAAB06366Medicare ID - Type Unspecified