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General NPI Number Information
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NPI Number | 1104692763
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Entity Type | Individual
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Provider Name | KATIE BLACK CPM, LM, RN
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 100 FOUNDERS WAY STE 5
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City | STRASBURG
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State | VA
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Zip | 22657-3791
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Country | US
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Telephone | 540-227-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 948 REFUGE CHURCH RD
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City | STEPHENS CITY
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State | VA
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Zip | 22655-5621
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Country | US
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Telephone | 703-217-3941
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0129000195
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License Number State | VA
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