Provider Demographics
NPI:1710854070
Name:MOONSTONE MIDWIFERY, LLC
Entity type:Organization
Organization Name:MOONSTONE MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SIOUX
Authorized Official - Last Name:RUEDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LDM, CPM, IBCLC
Authorized Official - Phone:541-621-6315
Mailing Address - Street 1:584 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9764
Mailing Address - Country:US
Mailing Address - Phone:541-621-6315
Mailing Address - Fax:888-543-0682
Practice Address - Street 1:584 JAMES ST
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9764
Practice Address - Country:US
Practice Address - Phone:541-621-6315
Practice Address - Fax:888-543-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty