Healthcare Provider Details

I. General information

NPI: 1528934205
Provider Name (Legal Business Name): MAPLE & MOON MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 OWL AVE
MARTINSBURG WV
25405-2401
US

IV. Provider business mailing address

148 OWL AVE
MARTINSBURG WV
25405-2401
US

V. Phone/Fax

Practice location:
  • Phone: 240-723-6575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DOMINIQUE GAGUI
Title or Position: OWNER
Credential:
Phone: 240-723-6575