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General NPI Number Information
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NPI Number | 1124471180
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Entity Type | Organization
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Legal Business Name | FAIRFAX HOME BIRTH
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 10805 NORMAN AVE
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City | FAIRFAX
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State | VA
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Zip | 22030-2932
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Country | US
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Telephone | 703-534-0373
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Fax | 703-543-9397
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Provider Business Mailing Address
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Address Line | 10805 NORMAN AVE
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City | FAIRFAX
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State | VA
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Zip | 22030-2932
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Country | US
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Telephone | 703-534-0373
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Fax | 703-543-9397
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Authorized Official
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Title or Position | NURSE MIDWIFE, OWNER
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Name | STORY JONES
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Credential | CNM
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Telephone | 703-534-0373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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