Healthcare Provider Details

I. General information

NPI: 1184035339
Provider Name (Legal Business Name): LEBANON VALLEY MIDWIFERY & WOMEN'S WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 HOST RD
WOMELSDORF PA
19567-9100
US

IV. Provider business mailing address

770 HOST RD
WOMELSDORF PA
19567-9100
US

V. Phone/Fax

Practice location:
  • Phone: 717-933-9743
  • Fax: 717-933-8289
Mailing address:
  • Phone: 717-933-9743
  • Fax: 717-933-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN FARRELL
Title or Position: OWNER
Credential: CNM
Phone: 717-933-9743