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General NPI Number Information
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NPI Number | 1447620810
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Entity Type | Organization
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Legal Business Name | KRISTINE TAWATER
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 4218 MAIN ST
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City | DALLAS
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State | TX
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Zip | 75226-1145
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Country | US
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Telephone | 214-914-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 4218 MAIN ST
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City | DALLAS
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State | TX
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Zip | 75226-1145
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Country | US
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Telephone | 214-914-5015
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Fax | 214-504-1964
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Authorized Official
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Title or Position | OWNER, MIDWIFE
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Name | KRISTINE TAWATER
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Credential | LM, CPM
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Telephone | 214-914-5015
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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 | 150044
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License Number State | TX
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