Healthcare Provider Details

I. General information

NPI: 1568911162
Provider Name (Legal Business Name): BIRTH SONG MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE SUITE 238
GRAND RAPIDS MI
49506-2762
US

IV. Provider business mailing address

1514 WEALTHY ST SE SUITE 238
GRAND RAPIDS MI
49506-2762
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-8144
  • Fax:
Mailing address:
  • Phone: 616-458-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. YOLANDA VISSER
Title or Position: MIDWIFE
Credential: CPM
Phone: 616-458-8144