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General NPI Number Information
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NPI Number | 1629225149
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Entity Type | Organization
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Legal Business Name | FULL SPECTRUM MIDWIFERY PC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 289 COLLEGE ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8320
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Country | US
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Telephone | 802-860-2229
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Fax |
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Provider Business Mailing Address
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Address Line | 289 COLLEGE ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8320
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Country | US
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Telephone | 802-860-2229
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PEGGY LYNN COHEN
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Credential | CPM, LM
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Telephone | 802-860-2229
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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 | 107-0000004
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License Number State | VT
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