=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093406332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELICATE DOULA SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2023
-----------------------------------------------------
Last Update Date | 05/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9849 BAILEY RD
-----------------------------------------------------
City | EAST JORDAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49727-9378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-838-3941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9849 BAILEY RD
-----------------------------------------------------
City | EAST JORDAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49727-9378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-838-3941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DIANE MARIE HAGUE
-----------------------------------------------------
Credential | CD
-----------------------------------------------------
Telephone | 231-838-3941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------