Provider Demographics
NPI:1831372929
Name:MOTHERWISE COMMUNITY BIRTH CENTER
Entity type:Organization
Organization Name:MOTHERWISE COMMUNITY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:541-318-6961
Mailing Address - Street 1:464 NE NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4387
Mailing Address - Country:US
Mailing Address - Phone:541-318-6961
Mailing Address - Fax:541-389-5345
Practice Address - Street 1:464 NE NORTON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4387
Practice Address - Country:US
Practice Address - Phone:541-318-6961
Practice Address - Fax:541-389-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-1589261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing