MEDICARE: MIDWIFE360, 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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP9247125	FL

General Provider Information

NPI Number	:	1538587332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWIFE360, LLC

Provider Business Mailing Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:	561-705-1022
Fax Number	:	561-530-2066

Provider Business Practice Location Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:	561-705-1022
Fax Number	:	561-530-2066

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAULA FADWAH HALABY
Credential	:	CNM
Telephone Number	:	561-558-7198

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	11/24/2021

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