Provider Demographics
NPI:1831580307
Name:SAMPLE, EVA (CPM, LM)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:NEWSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:127 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2022
Mailing Address - Country:US
Mailing Address - Phone:509-326-4366
Mailing Address - Fax:509-328-9266
Practice Address - Street 1:127 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2022
Practice Address - Country:US
Practice Address - Phone:509-326-4366
Practice Address - Fax:509-328-9266
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 60516027176B00000X
NM14124R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife