=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629843073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WISCONSIN DOULAS OF COLOR COLLECTIVE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2023
-----------------------------------------------------
Last Update Date | 11/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 W HAMPTON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-899-9245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5301 W HAMPTON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-899-9245
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. DEANNA THARPE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-213-7255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------