Healthcare Provider Details

I. General information

NPI: 1174427686
Provider Name (Legal Business Name): BIRTHING MIRACLES PREGNANCY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PARK AVE
BEAVER DAM WI
53916-2240
US

IV. Provider business mailing address

301 PARK AVE
BEAVER DAM WI
53916-2240
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-9819
  • Fax: 855-952-2022
Mailing address:
  • Phone: 608-723-9819
  • Fax: 855-952-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JOEY ANN LARSON
Title or Position: OWNER
Credential: LM, CPM
Phone: 608-723-9819