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General NPI Number Information
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NPI Number | 1558381228
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Entity Type | Individual
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Provider Name | EBONY S TATE CNM
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 4701 SANGAMORE RD STE N100
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City | BETHESDA
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State | MD
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Zip | 20816-2558
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Country | US
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Telephone | 914-919-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 SANGAMORE RD STE N100 PO BOX 367
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City | BETHESDA
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State | MD
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Zip | 20816-2558
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Country | US
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Telephone | 914-919-9200
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 109
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License Number State | NC
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