Healthcare Provider Details

I. General information

NPI: 1992154306
Provider Name (Legal Business Name): IN THE BEGINNING MIDWIFE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 NORTH MAIN STREET
IOLA WI
54945
US

IV. Provider business mailing address

PO BOX 402
IOLA WI
54945-0402
US

V. Phone/Fax

Practice location:
  • Phone: 715-445-2277
  • Fax: 866-933-1286
Mailing address:
  • Phone: 715-445-2277
  • Fax: 866-933-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number034-049
License Number StateWI

VIII. Authorized Official

Name: JANE CRAWFORD PETERSON
Title or Position: SOLE PROPRIETOR
Credential: LM, CPM
Phone: 715-445-2277