Tiffany Marie Wilson, LM, CPM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

60829254 Issued in WA

Practice address

22003 66TH Ave W # M5
Mountlake Terrace, WA 98043

Phone

(425) 321-0339

Fax

(425) 332-7208

NPI assigned

Feb 8, 2011

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1366748345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20201 12TH AVE W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980367182",
            "telephone_number": "425-321-0339",
            "fax_number": "425-332-7208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22003 66TH AVE W # M5",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "98043",
            "telephone_number": "425-321-0339",
            "fax_number": "425-332-7208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TIFFANY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LM, CPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-08",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "602996357",
            "primary": false
        },
        {
            "code": "175M00000X",
            "taxonomy_group": "",
            "desc": "Midwife, Lay",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "WA",
            "license": "60829254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60829254",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Midwife in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Midwife in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; 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.