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General NPI Number Information
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NPI Number | 1265965875
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Entity Type | Organization
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Legal Business Name | JUNOS PROMISE
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1178 S DELAWARE ST
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City | HOBART
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State | IN
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Zip | 46342-5886
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Country | US
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Telephone | 219-644-9048
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Fax |
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Provider Business Mailing Address
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Address Line | 1178 S DELAWARE ST
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City | HOBART
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State | IN
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Zip | 46342-5886
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Country | US
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Telephone | 219-644-9048
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Fax |
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Authorized Official
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Title or Position | DOULA
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Name | MRS. MICHELLE MICHNIEWICZ
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Credential |
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Telephone | 219-644-9048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number | SBD20110508
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License Number State | IN
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