Healthcare Provider Details

I. General information

NPI: 1366816738
Provider Name (Legal Business Name): EARTHLY MAMA BIRTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2015
Last Update Date: 11/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 SE NORMANDY AVE
STUART FL
34997-8559
US

IV. Provider business mailing address

5619 SE NORMANDY AVE
STUART FL
34997-8559
US

V. Phone/Fax

Practice location:
  • Phone: 908-500-8844
  • Fax:
Mailing address:
  • Phone: 908-500-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JORDANA DENN
Title or Position: DOULA
Credential:
Phone: 908-500-8844