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General NPI Number Information
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NPI Number | 1053670612
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Entity Type | Organization
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Legal Business Name | LAVENDER AND LACE BIRTH & WOMENS HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 310 JACOB STREET
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City | TIMPSON
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State | TX
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Zip | 75975-5028
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Country | US
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Telephone | 936-254-3338
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Fax | 936-254-3339
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Provider Business Mailing Address
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Address Line | 1204 GARNER ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4278
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Country | US
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Telephone | 409-789-8258
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCIA DEE NELSON
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Credential | RN., CNM
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Telephone | 409-789-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 251633
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License Number State | TX
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