Provider Demographics
NPI:1871716324
Name:SPOKANE MIDWIVES, PLLC
Entity type:Organization
Organization Name:SPOKANE MIDWIVES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STICKELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:509-326-4366
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000174176B00000X
WAMW00000229176B00000X
WACBC-025261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA501107001OtherGROUP HEALTH ID
WA7119209Medicaid
WA127058127058OtherPREMERA ID
ID806641700Medicaid
WA7069024Medicaid