Provider Demographics
NPI:1831431170
Name:HEALTHY WOMAN SEATTLE
Entity type:Organization
Organization Name:HEALTHY WOMAN SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:CNM ARNP
Authorized Official - Phone:626-905-9210
Mailing Address - Street 1:2511 NE 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7707
Mailing Address - Country:US
Mailing Address - Phone:425-366-7563
Mailing Address - Fax:
Practice Address - Street 1:8401 5TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4171
Practice Address - Country:US
Practice Address - Phone:425-366-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60239525176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty