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General NPI Number Information
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NPI Number | 1609578921
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Entity Type | Organization
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Legal Business Name | BLUE SAGE MIDWIFERY
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 3500 DUKE ST
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City | COLLEGE PARK
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State | MD
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Zip | 20740
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Country | US
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Telephone | 202-746-7801
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 DUKE ST
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City | COLLEGE PARK
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State | MD
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Zip | 20740
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Country | US
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Telephone | 202-746-7801
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Fax |
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Authorized Official
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Title or Position | OWNER, MIDWIFE
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Name | AZA NEDHARI
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Credential | LM, CPM, LGPC
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Telephone | 202-746-7801
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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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