Healthcare Provider Details

I. General information

NPI: 1992013817
Provider Name (Legal Business Name): WATER AND SPIRIT MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7588 CENTRAL PARKE BLVD SUITE 324
MASON OH
45040-6857
US

IV. Provider business mailing address

7588 CENTRAL PARKE BLVD SUITE 324
MASON OH
45040-6857
US

V. Phone/Fax

Practice location:
  • Phone: 513-432-8703
  • Fax:
Mailing address:
  • Phone: 513-432-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SORA COLVIN
Title or Position: OWNER
Credential:
Phone: 513-432-8703