Lynette Michelle Petibone

Primary specialty

MidwifeTaxonomy code 176B00000X

License

DEM-LD-10182635 Issued in OR

Practice address

14104 SW 121St Ave
Tigard, OR 97224-2818

Phone

(503) 443-6902

NPI assigned

Apr 25, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Lynette Michelle Pettibone Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lynette M Pettibone, LDM, LLC

  • Midwife
  • Vancouver, WA
  • NPI 1497400162
  NPD Authorized official
• The Bridge Birth Center

  • Birthing Clinic/Center
  • Vancouver, WA
  • NPI 1962157628
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1114285376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14104 SW 121ST AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242818",
            "telephone_number": "503-443-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14104 SW 121ST AVE",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972242818",
            "telephone_number": "503-443-6902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETIBONE",
        "first_name": "LYNETTE",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-25",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": "CA",
            "license": "P301",
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "OR",
            "license": "DEM-LD-10182635",
            "primary": true
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "WA",
            "license": "MW60719565",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNETTE",
            "last_name": "PETTIBONE",
            "middle_name": "MICHELLE",
            "prefix": "MRS.",
            "credential": "LM, LDM, CPM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amber Petersen
• Catherine Ann Petersen, LMT
• Daniele Paige Peterson, B.S.
• Hannah Marie Peterson
• Matthew Peterson, D.C.
• Kristine Marie Petrosyan, LMT
• Joshua Shane Pettigrew, D.C.
• Meagan Rene Pettigrove
• Karl Johan Pfalzgraff
• Mason Lorenzo Pfeifer

• Midwife in Tigard, OR
• Providers in Tigard, OR by specialty
• Midwife in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.