Individual
MRS. LYNETTE MICHELLE PETIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14104 SW 121ST AVE, TIGARD, OR 97224-2818
(503) 443-6902
Mailing address
14104 SW 121ST AVE, TIGARD, OR 97224-2818
(503) 443-6902
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
DEM-LD-10182635
OR
176B00000X
Midwife
MW60719565
WA
374J00000X
Doula
P301
CA
Other
Enumeration date
04/25/2012
Last updated
04/12/2017
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