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General NPI Number Information
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NPI Number | 1578331971
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Entity Type | Organization
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Legal Business Name | MIDWIFE GRACE, LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 340 BRAKEFIELD ST
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City | SLIDELL
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State | LA
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Zip | 70458-3620
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Country | US
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Telephone | 985-265-4032
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Fax | 985-202-4597
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Provider Business Mailing Address
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Address Line | 340 BRAKEFIELD ST
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City | SLIDELL
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State | LA
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Zip | 70458-3620
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Country | US
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Telephone | 985-265-4032
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Fax | 985-202-4597
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | GRACE JACKSON
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Credential | CPM
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Telephone | 985-773-0449
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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