Provider Demographics
NPI:1548045966
Name:WHARTON, BETTY GRACE (LM, CPM)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:GRACE
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1415
Mailing Address - Country:US
Mailing Address - Phone:509-521-2351
Mailing Address - Fax:
Practice Address - Street 1:3405 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4732
Practice Address - Country:US
Practice Address - Phone:509-949-2103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW61378907176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife