Healthcare Provider Details

I. General information

NPI: 1831602838
Provider Name (Legal Business Name): SACRED SPACE MIDWIFERY & HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CONTINENTAL DR
RENO NV
89509-3432
US

IV. Provider business mailing address

85 CONTINENTAL DR
RENO NV
89509-3432
US

V. Phone/Fax

Practice location:
  • Phone: 775-338-0755
  • Fax:
Mailing address:
  • Phone: 775-338-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM484
License Number StateCA

VIII. Authorized Official

Name: MS. TIFFANY HOFFMAN
Title or Position: OWNER, PRIMARY MIDWIFE
Credential: MS, LM, CPM
Phone: 775-338-0755