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General NPI Number Information
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NPI Number | 1336139757
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Entity Type | Organization
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Legal Business Name | BLUE MOON MIDWIVES LLC, PA
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 176 MAIN ST
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City | NORWAY
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State | ME
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Zip | 04268-5643
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Country | US
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Telephone | 207-739-2800
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Fax | 207-739-2877
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Provider Business Mailing Address
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Address Line | 176 MAIN ST
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City | NORWAY
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State | ME
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Zip | 04268-5643
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Country | US
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Telephone | 207-739-2800
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Fax | 207-739-2877
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Authorized Official
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Title or Position | PARTNER
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Name | MS. JANE E MILLS
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Credential | CNM
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Telephone | 207-739-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | R030353
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License Number State | ME
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