Healthcare Provider Details

I. General information

NPI: 1700741832
Provider Name (Legal Business Name): BLOSSOMING LOTUS BIRTHS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 SANDY LN APT 4403
WARWICK RI
02889-4352
US

IV. Provider business mailing address

212 SANDY LN APT 4403
WARWICK RI
02889-4352
US

V. Phone/Fax

Practice location:
  • Phone: 618-610-4453
  • Fax:
Mailing address:
  • Phone: 618-610-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDI REED
Title or Position: DOULA
Credential:
Phone: 618-610-4453