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General NPI Number Information
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NPI Number | 1083981625
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Entity Type | Organization
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Legal Business Name | ANCIENT ROOTS MIDWIFERY & DOULA CARE
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 829 BETHLEHEM CHURCH RD NE
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City | FLOYD
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State | VA
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Zip | 24091-2256
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Country | US
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Telephone | 540-285-0067
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Fax |
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Provider Business Mailing Address
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Address Line | 829 BETHLEHEM CHURCH RD NE
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City | FLOYD
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State | VA
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Zip | 24091-2256
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Country | US
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Telephone | 540-285-0067
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Fax |
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Authorized Official
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Title or Position | LACTATION CONSULTANT
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Name | TARA DAYSTAR
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Credential | BA, IBCLC, CPM
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Telephone | 540-285-0067
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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 | 0129000069
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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