Healthcare Provider Details

I. General information

NPI: 1730669805
Provider Name (Legal Business Name): HIS SACRED PATH MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N SAINT PAUL ST APT 2610
DALLAS TX
75201-4224
US

IV. Provider business mailing address

350 N SAINT PAUL ST APT 2610
DALLAS TX
75201-4224
US

V. Phone/Fax

Practice location:
  • Phone: 817-629-0722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAEVE NORTHCROSS
Title or Position: ADMIN
Credential:
Phone: 816-629-0722