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General NPI Number Information
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NPI Number | 1306387154
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Entity Type | Organization
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Legal Business Name | MIDWIVES RISING LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 115 W MCDOWELL RD STE 4B
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City | PHOENIX
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State | AZ
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Zip | 85003-1383
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Country | US
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Telephone | 602-242-4446
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Fax | 602-626-3555
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Provider Business Mailing Address
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Address Line | 115 W MCDOWELL RD STE 4B
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City | PHOENIX
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State | AZ
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Zip | 85003-1383
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Country | US
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Telephone | 602-242-4446
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Fax | 602-626-3555
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | SHELL LUTTRELL
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Credential | LM
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Telephone | 602-242-4446
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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 | LM148
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License Number State | AZ
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