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General NPI Number Information
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NPI Number | 1447818778
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Entity Type | Individual
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Provider Name | CAITLIN ANNA BOURNE CPM, LM
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Gender | Female
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Dates
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Enumeration Date | 06/02/2019
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Last Update Date | 06/02/2019
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Provider Practice Location Address
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Address Line | 1001 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-2513
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Country | US
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Telephone | 907-378-3735
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 FOX CREEK TRL
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City | DALLAS
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State | TX
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Zip | 75249-1615
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Country | US
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Telephone | 907-378-3735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 99382
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License Number State | TX
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