=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679274047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAMA LEONAS PERINATAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2023
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 67 KENYON ST APT 1
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-548-1584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67 KENYON ST APT 1
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-548-1584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOULA
-----------------------------------------------------
Name | MS. LEONA M SMITH
-----------------------------------------------------
Credential | CPD
-----------------------------------------------------
Telephone | 401-548-1584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------