Healthcare Provider Details

I. General information

NPI: 1629486212
Provider Name (Legal Business Name): WITH WOMEN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHURCH ST SUITE 204
EAST HARTFORD CT
06108-3720
US

IV. Provider business mailing address

PO BOX 280822
EAST HARTFORD CT
06128-0822
US

V. Phone/Fax

Practice location:
  • Phone: 888-607-0046
  • Fax: 888-690-0088
Mailing address:
  • Phone: 888-607-0046
  • Fax: 888-690-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number16000345
License Number StateCT

VIII. Authorized Official

Name: MICHELLE KILLINGSWORTH
Title or Position: MANAGER
Credential: CNM
Phone: 888-607-0046