Healthcare Provider Details

I. General information

NPI: 1003410861
Provider Name (Legal Business Name): JULIE BETH FERDMAN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403A WINDSOR ST
COLUMBIA MO
65201-5759
US

IV. Provider business mailing address

1403A WINDSOR ST
COLUMBIA MO
65201-5759
US

V. Phone/Fax

Practice location:
  • Phone: 314-374-8757
  • Fax: 573-314-4140
Mailing address:
  • Phone: 314-374-8757
  • Fax: 573-314-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: