Healthcare Provider Details

I. General information

NPI: 1871110668
Provider Name (Legal Business Name): FAITH CHRISTINE MOORHOUSE DOULA, PPD, CBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 23RD ST W
BRADENTON FL
34207-3216
US

IV. Provider business mailing address

5629 23RD ST W
BRADENTON FL
34207-3216
US

V. Phone/Fax

Practice location:
  • Phone: 941-538-7619
  • Fax:
Mailing address:
  • Phone: 941-538-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: