Healthcare Provider Details

I. General information

NPI: 1750728978
Provider Name (Legal Business Name): MERIDIAN CRAIG FAUL CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S HILLSIDE ST
WICHITA KS
67211-4001
US

IV. Provider business mailing address

910 S HILLSIDE ST
WICHITA KS
67211-4001
US

V. Phone/Fax

Practice location:
  • Phone: 830-388-9043
  • Fax:
Mailing address:
  • Phone: 830-388-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number13060009
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: