Healthcare Provider Details

I. General information

NPI: 1154864098
Provider Name (Legal Business Name): MIDWIFERYWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2016
Last Update Date: 11/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 COLBY ST STE 210
BERKELEY CA
94705-2059
US

IV. Provider business mailing address

2323 WARD ST
BERKELEY CA
94705-1110
US

V. Phone/Fax

Practice location:
  • Phone: 510-644-0104
  • Fax:
Mailing address:
  • Phone: 510-644-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number516
License Number StateCA

VIII. Authorized Official

Name: LINDA A JOHNSON
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: CNM
Phone: 510-644-0104