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General NPI Number Information
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NPI Number | 1306086855
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Entity Type | Organization
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Legal Business Name | COUNTRY LIFE MIDWIFERY SERVICES
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 4554 HILLTOP ROAD
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City | PEGRAM
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State | TN
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Zip | 37143
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Country | US
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Telephone | 615-646-7300
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Fax | 615-646-7331
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Provider Business Mailing Address
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Address Line | 4554 HILLTOP ROAD
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City | PEGRAM
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State | TN
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Zip | 37143
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Country | US
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Telephone | 615-646-7300
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Fax | 615-646-7331
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Authorized Official
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Title or Position | MIDWIFERY
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Name | MRS. HEATHER YVONE WILSON
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Credential | CNM
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Telephone | 615-646-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | CPM0000000007
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License Number State | TN
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