NPIMap

Organization Active NPI

Lynette M Pettibone, LDM, LLC

  • Midwife
  • Vancouver, WA
National Provider Identifier
1497400162
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
Legal business name
LYNETTE M PETTIBONE, LDM, LLC
Practice address
3300 NE 54TH St
Vancouver, WA 98663-1953
Phone
(206) 552-0061
Fax
(844) 822-7441
NPI assigned
Feb 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

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

Authorized official

Name
Lynette Michelle Petibone, LM, CPMNPI 1114285376
Title
Member/Manager/Director
Phone
(503) 443-6902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MidwifeGroup: 193400000X SINGLE SPECIALTY GROUP 176B00000X Primary

Addresses

Primary practice location

3300 NE 54TH St
Vancouver, WA 98663-1953

Mailing address

7720 NE Highway 99 # D441
Vancouver, WA 98665-8858
Phone (206) 552-0061

Other names 1

  • The Bridge Birth and Family Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lynette@bridgebirth.com

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1497400162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 NE HIGHWAY 99 # D441",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986658858",
            "telephone_number": "206-552-0061",
            "fax_number": "844-822-7441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 NE 54TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986631953",
            "telephone_number": "206-552-0061",
            "fax_number": "844-822-7441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNETTE M PETTIBONE, LDM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "PETIBONE",
        "authorized_official_first_name": "LYNETTE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "MEMBER/MANAGER/DIRECTOR",
        "authorized_official_telephone_number": "503-443-6902",
        "authorized_official_credential": "LM, CPM"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lynette@bridgebirth.com",
            "affiliation": "N",
            "address_1": "3300 NE 54th St",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986631953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Bridge Birth and Family Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; 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.