Provider Demographics
NPI:1982499125
Name:ROSS, TALIA IRENE (LM, CPM)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:IRENE
Last Name:ROSS
Suffix:
Gender:
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 TOTTEN INLET PL APT 5
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2081
Mailing Address - Country:US
Mailing Address - Phone:712-660-0682
Mailing Address - Fax:
Practice Address - Street 1:11505 BURNHAM DR STE 104A
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-9173
Practice Address - Country:US
Practice Address - Phone:253-632-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61664251176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty