Healthcare Provider Details

I. General information

NPI: 1275269649
Provider Name (Legal Business Name): GLOW PERINATAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HUBER AVE APT A4
PROVIDENCE RI
02909-5571
US

IV. Provider business mailing address

66 HUBER AVE APT A4
PROVIDENCE RI
02909-5571
US

V. Phone/Fax

Practice location:
  • Phone: 401-318-3069
  • Fax:
Mailing address:
  • Phone: 401-318-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MARIA ELENA PROUT
Title or Position: CERTIFIED PERINATAL DOULA
Credential:
Phone: 401-318-3069