Healthcare Provider Details

I. General information

NPI: 1780589804
Provider Name (Legal Business Name): MOTHER EARTH HOLISTIC BIRTHWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 IVY RIDGE RD APT 14
SYRACUSE NY
13210-4111
US

IV. Provider business mailing address

504 IVY RIDGE RD APT 14
SYRACUSE NY
13210-4111
US

V. Phone/Fax

Practice location:
  • Phone: 315-313-4324
  • Fax:
Mailing address:
  • Phone: 315-313-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: NYASA WILLIAMS
Title or Position: CERTIFIED POSTPARTUM DOULA
Credential: CPD
Phone: 315-313-4324