MEDICARE: MS. CARRIE REEDTZ SPARREVOHN 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	LM25	CA

General Provider Information

NPI Number	:	1790814143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE REEDTZ SPARREVOHN LM

Provider Business Mailing Address
First Line	:	10950 BACHELOR VALLEY RD
Second Line	:
City	:	WITTER SPRINGS
State	:	CA
Zip	:	95493-9734
Country	:	US
Telephone Number	:	530-304-3417
Fax Number	:

Provider Business Practice Location Address
First Line	:	10950 BACHELOR VALLEY RD
Second Line	:
City	:	WITTER SPRINGS
State	:	CA
Zip	:	95493-9734
Country	:	US
Telephone Number	:	530-304-3417
Fax Number	:

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

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	03/09/2016

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