Healthcare Provider Details

I. General information

NPI: 1831301415
Provider Name (Legal Business Name): NEW LIFE BIRTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9302 CASTLEWOOD DR
AUSTIN TX
78748-6010
US

IV. Provider business mailing address

9302 CASTLEWOOD DR
AUSTIN TX
78748-6010
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-5452
  • Fax: 512-477-5716
Mailing address:
  • Phone: 512-477-5452
  • Fax: 512-477-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number232731
License Number StateTX

VIII. Authorized Official

Name: MS. MARIMIKEL POTTER
Title or Position: OWNER, DIRECTOR
Credential: RN-BSN, LM, CPM
Phone: 512-477-5452