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General NPI Number Information
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NPI Number | 1376915314
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Entity Type | Organization
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Legal Business Name | MOONSTONE MIDWIVES INC.
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 4677 VALLEY EAST BLVD
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City | ARCATA
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State | CA
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Zip | 95521-4630
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Country | US
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Telephone | 707-223-1638
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Fax |
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Provider Business Mailing Address
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Address Line | 4677 VALLEY EAST BLVD
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City | ARCATA
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State | CA
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Zip | 95521-4630
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Country | US
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Telephone | 707-223-1638
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | LAURA ELIZABETH DOYLE
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Credential | LM, CPM
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Telephone | 707-223-1638
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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 | 361
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License Number State | CA
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