Healthcare Provider Details

I. General information

NPI: 1801396130
Provider Name (Legal Business Name): TANISHA DENISE MANNING BIRTH DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 S SAN JOAQUIN ST
STOCKTON CA
95202-3211
US

IV. Provider business mailing address

PO BOX 2492
CALIFORNIA CITY CA
93504-0492
US

V. Phone/Fax

Practice location:
  • Phone: 833-773-8895
  • Fax:
Mailing address:
  • Phone: 833-773-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: