Provider Demographics
NPI:1316466709
Name:BIRTH AND FAMILY MIDWIFERY, LLC
Entity type:Organization
Organization Name:BIRTH AND FAMILY MIDWIFERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:360-425-0861
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:CARROLLS
Mailing Address - State:WA
Mailing Address - Zip Code:98609-0048
Mailing Address - Country:US
Mailing Address - Phone:360-749-0010
Mailing Address - Fax:844-654-7171
Practice Address - Street 1:1514 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4102
Practice Address - Country:US
Practice Address - Phone:360-353-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty