MEDICARE: FULL CIRCLE WOMEN'S HEALTH AND BIRTH

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	367A00000X	Advanced Practice Midwife	209.006855	IL

General Provider Information

NPI Number	:	1437390523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE WOMEN'S HEALTH AND BIRTH

Provider Business Mailing Address
First Line	:	1961 W FARRAGUT AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-1382
Country	:	US
Telephone Number	:	713-569-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 W FARRAGUT AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60640-1382
Country	:	US
Telephone Number	:	713-569-5997
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED NURSE MIDWIFE / OWNER
Name	:	MS. AMY E WILLEN
Credential	:	CNM
Telephone Number	:	713-569-5997

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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