Provider Demographics
NPI:1255662722
Name:SEVERN, LOUISA WALES (LM, CPM)
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:WALES
Last Name:SEVERN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:LOUISA
Other - Last Name:WALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-0812
Mailing Address - Country:US
Mailing Address - Phone:206-954-2622
Mailing Address - Fax:206-451-8428
Practice Address - Street 1:26343 BARBER CUT OFF RD NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9401
Practice Address - Country:US
Practice Address - Phone:206-954-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60129702176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife