MEDICARE: CAITLIN ANNA BOURNE CPM, LM

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	99382	TX

General Provider Information

NPI Number	:	1447818778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ANNA BOURNE CPM, LM

Provider Business Mailing Address
First Line	:	8105 FOX CREEK TRL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75249-1615
Country	:	US
Telephone Number	:	907-378-3735
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2513
Country	:	US
Telephone Number	:	907-378-3735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2019
Last Update Date	:	06/02/2019

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