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General NPI Number Information
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NPI Number | 1386340941
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Entity Type | Organization
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Legal Business Name | RIVERBEND MIDWIFERY, LLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 2010 EVERGREEN AVE SW
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City | LIVE OAK
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State | FL
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Zip | 32064-4421
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Country | US
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Telephone | 386-984-9716
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Fax | 386-401-2312
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Provider Business Mailing Address
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Address Line | PO BOX 1002
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City | LAKE CITY
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State | FL
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Zip | 32056-1002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSALIE BLACKWELL
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Credential | LM
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Telephone | 386-984-9716
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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 |
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License Number State |
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