=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184324089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN MANUELA VALVERDE CLC, DOULA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2023
-----------------------------------------------------
Last Update Date | 03/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10850 US HIGHWAY 50
-----------------------------------------------------
City | DODGE CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67801-6538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-253-7924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 902
-----------------------------------------------------
City | DODGE CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67801-0902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-253-7924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number | CVA-105063
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | ALPP-331740
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------