Healthcare Provider Details

I. General information

NPI: 1386858017
Provider Name (Legal Business Name): DAMARIS EDMONSTONE PITTMAN LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7024 QUEENSBERRY DR
CHARLOTTE NC
28226-7657
US

IV. Provider business mailing address

7024 QUEENSBERRY DR
CHARLOTTE NC
28226-7657
US

V. Phone/Fax

Practice location:
  • Phone: 704-542-9656
  • Fax:
Mailing address:
  • Phone: 704-542-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLMW15
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: