Healthcare Provider Details

I. General information

NPI: 1295162014
Provider Name (Legal Business Name): JESSICA HULDERMAN DOULA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2013
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 LAKE SHORE BLVD
PORT WENTWORTH GA
31407-3632
US

IV. Provider business mailing address

52 LAKE SHORE BLVD
PORT WENTWORTH GA
31407-3632
US

V. Phone/Fax

Practice location:
  • Phone: 419-704-8105
  • Fax:
Mailing address:
  • Phone: 419-704-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JESSICA S HULDERMAN
Title or Position: DOULA
Credential: CPD
Phone: 419-704-8105