Healthcare Provider Details

I. General information

NPI: 1396781720
Provider Name (Legal Business Name): BEVERLY WOODARD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 27TH ST FL 4 FRUITION MIDWIFERY
NEW YORK NY
10001-6226
US

IV. Provider business mailing address

118 HERBERT AVE FRUITION MIDWIFERY
ELMONT NY
11003-1229
US

V. Phone/Fax

Practice location:
  • Phone: 646-638-9388
  • Fax: 212-463-9526
Mailing address:
  • Phone: 646-638-9388
  • Fax: 516-358-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: