Healthcare Provider Details

I. General information

NPI: 1437787124
Provider Name (Legal Business Name): KAI BADER LYONS CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4492 THREE NOTCH D RD
CHARLOTTESVILLE VA
22901-6378
US

IV. Provider business mailing address

5 GILDERSLEEVE WOOD
CHARLOTTESVILLE VA
22903-3207
US

V. Phone/Fax

Practice location:
  • Phone: 434-981-3678
  • Fax:
Mailing address:
  • Phone: 434-981-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129-000163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: