Healthcare Provider Details

I. General information

NPI: 1548663578
Provider Name (Legal Business Name): WILLOW BIRTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 10/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 ASHLEY DR
OKLAHOMA CITY OK
73120-3809
US

IV. Provider business mailing address

2217 ASHLEY DR
OKLAHOMA CITY OK
73120-3809
US

V. Phone/Fax

Practice location:
  • Phone: 405-326-4800
  • Fax:
Mailing address:
  • Phone: 405-326-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number8404
License Number StateOK

VIII. Authorized Official

Name: BRANDY HARRIS
Title or Position: OWNER
Credential: CD (DONA)
Phone: 405-326-4800