Organization
BRIGHT EYES MIDWIFERY AND WILD RIVERS WOMENS HEALTH,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN WEBER DOUGHERTY (OFFICE MANAGER)
(541) 260-5762
Entity
Organization
Contact information
Practice address
29135 ELLENSBURG AVE, GOLD BEACH, OR 97444-8722
(541) 260-5762
Mailing address
PO BOX 1710, GOLD BEACH, OR 97444-1710
(541) 260-5762
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
200950160NP
OR
367A00000X
Advanced Practice Midwife
000031286N5
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172189
—
OR
05
—
500614877
—
OR
Enumeration date
02/27/2014
Last updated
02/27/2014
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