Provider Demographics
NPI:1861036410
Name:GILPATRICK, CYRENA (LM, CPM, MSM)
Entity Type:Individual
Prefix:
First Name:CYRENA
Middle Name:
Last Name:GILPATRICK
Suffix:
Gender:F
Credentials:LM, CPM, MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4324
Mailing Address - Country:US
Mailing Address - Phone:360-336-5658
Mailing Address - Fax:360-336-5655
Practice Address - Street 1:916 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4324
Practice Address - Country:US
Practice Address - Phone:360-336-5658
Practice Address - Fax:360-336-5655
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61004742176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2145441Medicaid