Healthcare Provider Details

I. General information

NPI: 1316643166
Provider Name (Legal Business Name): AUDREY REES LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BOHEMIAN LN
OCCIDENTAL CA
95465-9115
US

IV. Provider business mailing address

1101 BOHEMIAN LN
OCCIDENTAL CA
95465-9115
US

V. Phone/Fax

Practice location:
  • Phone: 707-407-7657
  • Fax:
Mailing address:
  • Phone: 707-407-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: