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General NPI Number Information
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NPI Number | 1437771755
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Entity Type | Organization
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Legal Business Name | INDIAN CREEK MIDWIFERY & BIRTH CENTER, PLLC
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 132 INDIAN CREEK RD
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City | ITHACA
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State | NY
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Zip | 14850-1331
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Country | US
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Telephone | 607-793-3794
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Fax | 607-821-4374
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Provider Business Mailing Address
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Address Line | 574 S DANBY RD
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City | SPENCER
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State | NY
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Zip | 14883-9606
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Country | US
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Telephone | 607-379-9606
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Fax |
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Authorized Official
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Title or Position | MIDWIFERY DIRECTOR/OWNER
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Name | LISA M BENEDETTO
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Credential | CNM
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Telephone | 607-379-9606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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