Healthcare Provider Details

I. General information

NPI: 1962310458
Provider Name (Legal Business Name): MOTHER BLOOM WOMENS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S STATE ST STE 215
ANN ARBOR MI
48104-7103
US

IV. Provider business mailing address

11150 BOYCE RD
CHELSEA MI
48118-9411
US

V. Phone/Fax

Practice location:
  • Phone: 734-395-5868
  • Fax:
Mailing address:
  • Phone: 734-395-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA R FERNANDEZ
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: CNM
Phone: 734-395-5868