Healthcare Provider Details

I. General information

NPI: 1679201487
Provider Name (Legal Business Name): OHANA MIDWIFERY & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E ROSEBORO ST
ROSEBORO NC
28382
US

IV. Provider business mailing address

PO BOX 768
ROSEBORO NC
28382-0768
US

V. Phone/Fax

Practice location:
  • Phone: 910-260-2050
  • Fax: 910-500-5002
Mailing address:
  • Phone: 910-260-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: LAURA OWEN GRAY
Title or Position: OWNER
Credential:
Phone: 910-260-2050