Healthcare Provider Details

I. General information

NPI: 1275849689
Provider Name (Legal Business Name): LEBANON VALLEY MIDWIFERY AND WOMEN'S WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
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 TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP010234
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010099
License Number StatePA

VIII. Authorized Official

Name: SUSAN N FARRELL
Title or Position: DIRECTOR
Credential: MSN, CNM, CRNP-WH
Phone: 717-933-9743