Healthcare Provider Details

I. General information

NPI: 1427491067
Provider Name (Legal Business Name): WHOLISTIC MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 04/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13037 FENCEROW RD
FORT WORTH TX
76244-8103
US

IV. Provider business mailing address

13037 FENCEROW RD
FORT WORTH TX
76244-8103
US

V. Phone/Fax

Practice location:
  • Phone: 214-680-0956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99174
License Number StateTX

VIII. Authorized Official

Name: GINA R PHILLIPS
Title or Position: MIDWIFE
Credential: CPM, LM
Phone: 214-680-0956