=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265973952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE WITHIN BIRTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2017
-----------------------------------------------------
Last Update Date | 03/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 COLONY RD
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-377-8757
-----------------------------------------------------
Fax | 717-754-0604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 504 COLONY RD
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-377-8757
-----------------------------------------------------
Fax | 717-754-0604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED PROFESSIONAL MIDWIFE
-----------------------------------------------------
Name | JENNIFER R WEESE
-----------------------------------------------------
Credential | C.P.M.
-----------------------------------------------------
Telephone | 717-377-8757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------