Healthcare Provider Details

I. General information

NPI: 1316412687
Provider Name (Legal Business Name): RACHEL TILLER DEM MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 FT JEFFERSON AVE
GREENVILLE OH
45331-4533
US

IV. Provider business mailing address

1196 FORT JEFFERSON AVE
GREENVILLE OH
45331-1044
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-7894
  • Fax:
Mailing address:
  • Phone: 937-548-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: