Healthcare Provider Details

I. General information

NPI: 1861827057
Provider Name (Legal Business Name): SANTA ROSA MIDWIFERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

IV. Provider business mailing address

4415 SONOMA HWY STE B
SANTA ROSA CA
95409-4165
US

V. Phone/Fax

Practice location:
  • Phone: 707-539-1544
  • Fax: 707-539-0686
Mailing address:
  • Phone: 707-539-1544
  • Fax: 707-539-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1382
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH POINTER SMITH
Title or Position: OWNER
Credential: CNM
Phone: 707-539-1544