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General NPI Number Information
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NPI Number | 1497270763
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Entity Type | Organization
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Legal Business Name | THE NEST BIRTH CENTER, PLLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 208 E BROAD ST
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City | MANSFIELD
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State | TX
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Zip | 76063-7703
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Country | US
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Telephone | 817-691-0856
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Fax | 817-549-2575
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Provider Business Mailing Address
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Address Line | 208 E. BROAD STREET 104
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City | MANSFIELD
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State | TX
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Zip | 76063-1790
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Country | US
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Telephone | 817-691-0856
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Fax | 817-691-0856
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA M. RIELL
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Credential | CPM, LM
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Telephone | 817-691-0856
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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 | 999233
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License Number State | TX
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