Healthcare Provider Details

I. General information

NPI: 1164095659
Provider Name (Legal Business Name): AROUND THE MOON DOULA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HANNA ST
FORT WAYNE IN
46806-4743
US

IV. Provider business mailing address

4421 HANNA ST
FORT WAYNE IN
46806-4743
US

V. Phone/Fax

Practice location:
  • Phone: 317-820-0744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIANA MYCHELLE JONES
Title or Position: CEO/DOULA
Credential: DOULA
Phone: 765-535-8700