Provider Demographics
NPI:1437406071
Name:MATHIS, ELIZABETH F (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:F
Last Name:MATHIS
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 N DAKOTA CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7520
Mailing Address - Country:US
Mailing Address - Phone:360-721-5121
Mailing Address - Fax:
Practice Address - Street 1:16621 N DAKOTA CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7520
Practice Address - Country:US
Practice Address - Phone:360-721-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
WABD61502574374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABD61561502574Medicaid