Healthcare Provider Details

I. General information

NPI: 1538587332
Provider Name (Legal Business Name): MIDWIFE360, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 1/2 S DIXIE HWY
WEST PALM BEACH FL
33405-2227
US

IV. Provider business mailing address

3621 1/2 S DIXIE HWY
WEST PALM BEACH FL
33405-2227
US

V. Phone/Fax

Practice location:
  • Phone: 561-705-1022
  • Fax: 561-530-2066
Mailing address:
  • Phone: 561-705-1022
  • Fax: 561-530-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9247125
License Number StateFL

VIII. Authorized Official

Name: MS. PAULA FADWAH HALABY
Title or Position: OWNER
Credential: CNM
Phone: 561-558-7198