=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487269049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINEAPPLE BABIES BIRTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2020
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2908 RYAN CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-7231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-442-3858
-----------------------------------------------------
Fax | 877-827-9795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2908 RYAN CT
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-7231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | AMY KEILLOR
-----------------------------------------------------
Credential | CPM, LM
-----------------------------------------------------
Telephone | 502-442-3858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------