Healthcare Provider Details

I. General information

NPI: 1053814723
Provider Name (Legal Business Name): WOMB TO TOMB WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E JEFFERSON ST
VIROQUA WI
54665-1730
US

IV. Provider business mailing address

PO BOX 303
VIROQUA WI
54665-0303
US

V. Phone/Fax

Practice location:
  • Phone: 608-571-4007
  • Fax:
Mailing address:
  • Phone: 608-571-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA B ESTEP
Title or Position: OWNER
Credential: BSN, RN
Phone: 608-571-4007