Healthcare Provider Details

I. General information

NPI: 1477019107
Provider Name (Legal Business Name): CITY OF OAKS MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRAIL SUITE 405
RALEIGH NC
27607-7520
US

IV. Provider business mailing address

200 PERIMETER PARK DR SUITE B
MORRISVILLE NC
27560
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-8225
  • Fax: 919-876-3371
Mailing address:
  • Phone: 919-334-0123
  • Fax: 919-334-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELIA M BALDWIN
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 919-334-0150