Provider Demographics
NPI:1750616215
Name:COMMUNITY MIDWIVES OF WESTERN WASHINGTON, PLLC
Entity type:Organization
Organization Name:COMMUNITY MIDWIVES OF WESTERN WASHINGTON, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE & CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:425-296-1392
Mailing Address - Street 1:15718 76TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4236
Mailing Address - Country:US
Mailing Address - Phone:425-296-1392
Mailing Address - Fax:425-239-5753
Practice Address - Street 1:15718 76TH PL NE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4236
Practice Address - Country:US
Practice Address - Phone:425-296-1392
Practice Address - Fax:425-239-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60057957176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty