MEDICARE: VITA NOVA BIRTHING

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	374J00000X	Doula

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801401419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITA NOVA BIRTHING

Provider Business Mailing Address
First Line	:	701 E CATHEDRAL RD # 45-202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E CATHEDRAL RD # 45-202
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	267-225-7194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABBY NWOGA
Credential	:	CD
Telephone Number	:	267-225-7194

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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Directions to “VITA NOVA BIRTHING ” Practice Location

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