=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336945260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARTHLY DOULA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2025
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 SW 12TH AVE
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-232-1133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 SW 12TH AVE
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33069-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-232-1133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BIRTH DOULA
-----------------------------------------------------
Name | MS. DIEULENE JEAN LOUIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-232-1133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------