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General NPI Number Information
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NPI Number | 1497281075
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE BIRTH CENTER
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 1003 MAHONE ST SUITE 102
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-6214
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Country | US
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Telephone | 540-841-4863
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Fax | 540-227-7472
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Provider Business Mailing Address
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Address Line | 1003 MAHONE ST SUITE 102
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-6214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEAH PAUL
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Credential | CPM LM
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Telephone | 540-841-4863
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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 | 0129000114
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 0129000033
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License Number State | VA
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