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General NPI Number Information
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NPI Number | 1467701805
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Entity Type | Organization
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Legal Business Name | BIRTH AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 769 W TERRA LN
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City | O FALLON
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State | MO
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Zip | 63366-2432
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Country | US
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Telephone | 314-369-8637
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Fax | 877-533-4456
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Provider Business Mailing Address
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Address Line | 27880 BEVERLY DR
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City | WRIGHT CITY
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State | MO
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Zip | 63390-4449
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Country | US
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Telephone | 314-369-8637
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Fax | 877-533-4456
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Authorized Official
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Title or Position | DIRECTOR
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Name | JESSICA HENMAN
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Credential | CNM
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Telephone | 314-369-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 100863
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 2010015977
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License Number State | MO
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