Healthcare Provider Details

I. General information

NPI: 1821354986
Provider Name (Legal Business Name): MAEVE NORTHCROSS CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENEE MARLEEN OHRVALL CPM, LM

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 MCFARRING DR
FORT WORTH TX
76244-5898
US

IV. Provider business mailing address

9804 MCFARRING DR
FORT WORTH TX
76244-5898
US

V. Phone/Fax

Practice location:
  • Phone: 817-629-0722
  • Fax: 512-870-9232
Mailing address:
  • Phone: 817-629-0722
  • Fax: 512-870-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: