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General NPI Number Information
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NPI Number | 1003452707
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Entity Type | Organization
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Legal Business Name | DIVINE LOTUS DOULA AND WOMB CARE, LLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 2025 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-4657
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Country | US
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Telephone | 941-242-5368
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 17TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-4657
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Country | US
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Telephone | 941-242-5368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LATIKIA CUNNIEN
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Credential |
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Telephone | 941-242-5368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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