Healthcare Provider Details

I. General information

NPI: 1407991870
Provider Name (Legal Business Name): EDYTHE WELLS C.P.M., L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 W FINLEY RD
BELOIT WI
53511-8738
US

IV. Provider business mailing address

2939 W FINLEY RD
BELOIT WI
53511-8738
US

V. Phone/Fax

Practice location:
  • Phone: 608-362-6464
  • Fax: 775-587-2178
Mailing address:
  • Phone: 608-362-6464
  • Fax: 775-587-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number18 - 49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: