Healthcare Provider Details

I. General information

NPI: 1588253934
Provider Name (Legal Business Name): GENTLE SPIRIT HOME BIRTH MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 SELWYN AVE STE 130
CHARLOTTE NC
28209-1786
US

IV. Provider business mailing address

130 SHARON TOWNSHIP LN APT 504
CHARLOTTE NC
28211-4392
US

V. Phone/Fax

Practice location:
  • Phone: 704-420-0420
  • Fax: 866-308-6063
Mailing address:
  • Phone: 201-304-3248
  • Fax: 866-308-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAKINA O'UHURU
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 704-420-0424