Healthcare Provider Details

I. General information

NPI: 1891161188
Provider Name (Legal Business Name): GENTLE HARBOR MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1793 NEWMAN TER
BENTON HARBOR MI
49022-6532
US

IV. Provider business mailing address

1793 NEWMAN TER
BENTON HARBOR MI
49022-6532
US

V. Phone/Fax

Practice location:
  • Phone: 269-470-2611
  • Fax:
Mailing address:
  • Phone: 269-470-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: TERRIE SUE LENLEY
Title or Position: OWNER
Credential: CNM
Phone: 269-470-2611