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General NPI Number Information
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NPI Number | 1174258412
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Entity Type | Organization
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Legal Business Name | SACRED DIVINE FEMININITY, LLC.
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 4906 RICHMOND ST STE 6
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City | ERIE
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State | PA
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Zip | 16509-1978
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Country | US
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Telephone | 814-299-9550
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 BRANDES ST
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City | ERIE
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State | PA
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Zip | 16504-3002
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Country | US
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Telephone | 814-460-3205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHAWNTA' PULLIAM-BROWN
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Credential | BCNWP,CNHP,CD(DONA)
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Telephone | 814-460-3205
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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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Taxonomy #2
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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