=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194983627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA HESS AMIRAULT CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2008
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1580 VALENCIA ST SUITE 508
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-4423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-641-6996
-----------------------------------------------------
Fax | 415-641-6899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3555 CESAR CHAVEZ SUITE 112
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-641-6452
-----------------------------------------------------
Fax | 415-641-6899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | NMW1772
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------