Provider Demographics
NPI:1780232397
Name:SEIDEWAND, AMY LOUISE (LM, CPM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:SEIDEWAND
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 EAGLEMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325-8760
Mailing Address - Country:US
Mailing Address - Phone:831-332-6519
Mailing Address - Fax:
Practice Address - Street 1:20696 BOND RD NE STE 110
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9025
Practice Address - Country:US
Practice Address - Phone:360-779-0004
Practice Address - Fax:206-260-1261
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60977859176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife