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General NPI Number Information
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NPI Number | 1104362938
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Entity Type | Organization
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Legal Business Name | MATERNAL INSTINCT DOULAS
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 4899 UNDERWOOD ST
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City | DETROIT
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State | MI
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Zip | 48204-2126
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Country | US
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Telephone | 602-430-2589
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 METROVIEW PKWY 278
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1514
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Country | US
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Telephone | 602-430-2589
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NANCY ANN BASKERVILLE
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Credential | RN
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Telephone | 602-430-2589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 22616900
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License Number State | NY
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