MEDICARE: RISING MOON BIRTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	0129000034	VA

General Provider Information

NPI Number	:	1194032557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING MOON BIRTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	4 SPRINGWOOD LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-2904
Country	:	US
Telephone Number	:	610-469-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 SPRINGWOOD LN
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-2904
Country	:	US
Telephone Number	:	610-469-4905
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MIDWIFE
Name	:	KATHRYN A ASERON
Credential	:	CPM
Telephone Number	:	610-469-4905

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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