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General NPI Number Information
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NPI Number | 1649568890
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Entity Type | Organization
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Legal Business Name | WELLSPRING FAMILY MIDWIFERY
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 839 9TH ST
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City | ARCATA
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State | CA
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Zip | 95521-6229
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Country | US
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Telephone | 707-845-7925
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Fax | 707-442-3955
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Provider Business Mailing Address
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Address Line | PO BOX 4328
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City | ARCATA
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State | CA
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Zip | 95518-4328
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Country | US
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Telephone | 707-845-7925
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Fax | 707-442-3955
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Authorized Official
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Title or Position | LICENSED MIDWIFE, PARTNER
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Name | DEANNA ALBO DICK
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Credential | LM, CPM
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Telephone | 707-845-7925
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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 | LM 274
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM 308
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License Number State | CA
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