Healthcare Provider Details

I. General information

NPI: 1679104962
Provider Name (Legal Business Name): BIRTHING TRADITIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 ROAD 11
POWELL WY
82435-9131
US

IV. Provider business mailing address

751 ROAD 11
POWELL WY
82435-9131
US

V. Phone/Fax

Practice location:
  • Phone: 307-202-2386
  • Fax: 307-754-5892
Mailing address:
  • Phone: 307-202-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE LENNON
Title or Position: MIDWIFE
Credential: CPM, LM
Phone: 307-202-2386