Provider Demographics
NPI:1386079572
Name:DELLA VITA MIDWIFERY
Entity type:Organization
Organization Name:DELLA VITA MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:360-719-2171
Mailing Address - Street 1:16107 NE 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9553
Mailing Address - Country:US
Mailing Address - Phone:360-901-7593
Mailing Address - Fax:
Practice Address - Street 1:11801 NE 65TH ST STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5527
Practice Address - Country:US
Practice Address - Phone:360-719-2171
Practice Address - Fax:360-719-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007116367A00000X
WAAP30004086367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8904127OtherPTAN
G8904128OtherPTAN
WA1005793Medicaid
WA1044459Medicaid
1245255660OtherNPI
1497770812OtherNPI