Healthcare Provider Details

I. General information

NPI: 1962024877
Provider Name (Legal Business Name): DC MOBILE MIDWIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5227 CHILLUM PL NE
WASHINGTON DC
20011-6417
US

IV. Provider business mailing address

5518 8TH ST S
ARLINGTON VA
22204-2616
US

V. Phone/Fax

Practice location:
  • Phone: 202-630-7177
  • Fax:
Mailing address:
  • Phone: 202-630-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN TUCKER
Title or Position: OWNER, CERTIFIED NURSE MIDWIFE
Credential: CNM
Phone: 202-630-7177