Healthcare Provider Details

I. General information

NPI: 1528556560
Provider Name (Legal Business Name): MW MIDWIFERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 ENTERPRISE RD
GREENSBORO NC
27408-7004
US

IV. Provider business mailing address

2122 ENTERPRISE RD
GREENSBORO NC
27408-7004
US

V. Phone/Fax

Practice location:
  • Phone: 336-763-5123
  • Fax:
Mailing address:
  • Phone: 336-763-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number137081
License Number StateNC

VIII. Authorized Official

Name: TANYA BAILEY
Title or Position: OWNER / ADMINISTRATOR
Credential: CNM
Phone: 336-456-3896