Provider Demographics
NPI:1982951018
Name:GOBER, JUANITA MICHELLE (MIDWIFE, CPM, LM)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MICHELLE
Last Name:GOBER
Suffix:
Gender:F
Credentials:MIDWIFE, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 4TH AVE E
Mailing Address - Street 2:PMB #51
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4632
Mailing Address - Country:US
Mailing Address - Phone:817-773-0588
Mailing Address - Fax:360-841-7759
Practice Address - Street 1:1910 4TH AVE E
Practice Address - Street 2:PMB #51
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4632
Practice Address - Country:US
Practice Address - Phone:817-773-0588
Practice Address - Fax:360-841-7759
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60434821176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife