Provider Demographics
NPI:1740631910
Name:DARLIN, JAQXUN RAE (LDM, CPM)
Entity type:Individual
Prefix:
First Name:JAQXUN
Middle Name:RAE
Last Name:DARLIN
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:RAE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:7720 NE HIGHWAY 99 STE D441
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8858
Mailing Address - Country:US
Mailing Address - Phone:206-552-0061
Mailing Address - Fax:844-822-7441
Practice Address - Street 1:3300 NE 54TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1953
Practice Address - Country:US
Practice Address - Phone:206-552-0061
Practice Address - Fax:844-822-7441
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMW61233724OtherLICENSED MIDWIFE