Healthcare Provider Details

I. General information

NPI: 1184449860
Provider Name (Legal Business Name): AUTHENTIC MIDWIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 108TH PL STE 100
WAUWATOSA WI
53226-4253
US

IV. Provider business mailing address

2864 S WAUKESHA RD
WEST ALLIS WI
53227-2834
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-3177
  • Fax: 414-375-2048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: KATY SKARLATOS
Title or Position: OWNER
Credential: CPM, LM
Phone: 414-617-3177