Provider Demographics
NPI:1770054223
Name:ANACORTES MIDWIFERY CARE LLC
Entity type:Organization
Organization Name:ANACORTES MIDWIFERY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MONTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ARNP, CNM
Authorized Official - Phone:360-298-8044
Mailing Address - Street 1:902 7TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-4104
Mailing Address - Country:US
Mailing Address - Phone:360-298-8044
Mailing Address - Fax:
Practice Address - Street 1:902 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4104
Practice Address - Country:US
Practice Address - Phone:360-298-8044
Practice Address - Fax:216-930-5958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047740Medicaid