Healthcare Provider Details

I. General information

NPI: 1134176555
Provider Name (Legal Business Name): CHRISTINE LEAH COX JUDE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N BETHLEHEM PIKE BUILDING B UNIT A-2
LOWER GWYNEDD PA
19002-2534
US

IV. Provider business mailing address

4608 SPRUCE ST
PHILADELPHIA PA
19139-4617
US

V. Phone/Fax

Practice location:
  • Phone: 215-249-9646
  • Fax: 215-249-3786
Mailing address:
  • Phone: 215-249-9646
  • Fax: 215-249-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW010068
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: