Healthcare Provider Details

I. General information

NPI: 1346472586
Provider Name (Legal Business Name): WELL ROUNDED MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 DRY VALLEY RD
RADFORD VA
24141-6303
US

IV. Provider business mailing address

4725 DRY VALLEY RD
RADFORD VA
24141-6303
US

V. Phone/Fax

Practice location:
  • Phone: 540-382-3031
  • Fax:
Mailing address:
  • Phone: 540-382-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000042
License Number StateVA

VIII. Authorized Official

Name: MRS. ALICIA C. KING
Title or Position: CEO
Credential: MIDWIFE
Phone: 540-382-3031