Healthcare Provider Details

I. General information

NPI: 1598308488
Provider Name (Legal Business Name): AURIELLE LANAI FIELDS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4762 W COMMERCE ST
HERNANDO MS
38632-8436
US

IV. Provider business mailing address

1703 WARNER AVE
JONESBORO AR
72401-3739
US

V. Phone/Fax

Practice location:
  • Phone: 901-878-5978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number87
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: