Healthcare Provider Details

I. General information

NPI: 1699610147
Provider Name (Legal Business Name): WILLOW ELAINE LENOIR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8837 N CITRUS AVE
CRYSTAL RIVER FL
34428-7047
US

IV. Provider business mailing address

8837 N CITRUS AVE
CRYSTAL RIVER FL
34428-7047
US

V. Phone/Fax

Practice location:
  • Phone: 352-584-0209
  • Fax:
Mailing address:
  • Phone: 352-584-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11045017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: