Healthcare Provider Details

I. General information

NPI: 1164662748
Provider Name (Legal Business Name): MOBILE MIDWIFE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12945 W DIXIE HWY
NORTH MIAMI FL
33161-4809
US

IV. Provider business mailing address

930 NE 205TH ST
MIAMI FL
33179-1918
US

V. Phone/Fax

Practice location:
  • Phone: 786-975-9222
  • Fax: 786-513-0380
Mailing address:
  • Phone: 786-975-9222
  • Fax: 786-513-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW208
License Number StateFL

VIII. Authorized Official

Name: MRS. ADA REBECA SPROUSE
Title or Position: LICENSED MIDWIFE
Credential:
Phone: 786-975-9222