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General NPI Number Information
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NPI Number | 1699283150
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Entity Type | Organization
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Legal Business Name | CANE CREEK MIDWIFERY, LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 2281 MORGAN BRANCH RD
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City | PLEASANTVILLE
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State | TN
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Zip | 37033-2001
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Country | US
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Telephone | 931-622-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 2281 MORGAN BRANCH RD
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City | PLEASANTVILLE
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State | TN
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Zip | 37033-2001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MR. GORDON MARK SHAFER
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Credential |
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Telephone | 931-622-3560
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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 | CPM-TN000000046
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License Number State | TN
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