Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 97030003 | OH |
NPI | 1114017902 |
---|---|
Provider Name | Claudette Louise Coughenour |
First Address | Petaluma, CA 94954-5848 |
Second Address | Petaluma, CA 94954-5848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12280 | LAMAZE (01) | CA |
97030003 | CERTIFIED MIDWIFE (01) | CA |