Healthcare Provider Details

I. General information

NPI: 1093285637
Provider Name (Legal Business Name): COBBLESTONE MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5617 ASHLEY SQUARE SOUTH
MEMPHIS TN
38120
US

IV. Provider business mailing address

5617 ASHLEY SQUARE SOUTH
MEMPHIS TN
38120
US

V. Phone/Fax

Practice location:
  • Phone: 206-261-2312
  • Fax:
Mailing address:
  • Phone: 206-261-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: JODILYN OWEN
Title or Position: LICENSED MIDWIFE, OWNER
Credential: LCPM
Phone: 206-261-2312