Healthcare Provider Details

I. General information

NPI: 1104140888
Provider Name (Legal Business Name): HONOR OUR MOTHERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 2ND ST E
CRESCO IA
52136-1121
US

IV. Provider business mailing address

615 2ND ST E
CRESCO IA
52136-1121
US

V. Phone/Fax

Practice location:
  • Phone: 641-220-5135
  • Fax: 563-203-9149
Mailing address:
  • Phone: 641-220-5135
  • Fax: 563-203-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DONNA MAE REICKS
Title or Position: MIDWIFE
Credential:
Phone: 641-220-5135