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General NPI Number Information
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NPI Number | 1710718630
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Entity Type | Individual
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Provider Name | TABITHA MIRANDA FAUST CPM
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Gender | Female
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 459 COUNTY ROAD 917
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City | THEODOSIA
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State | MO
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Zip | 65761-6155
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 459 COUNTY ROAD 917
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City | THEODOSIA
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State | MO
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Zip | 65761-6155
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Country | US
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Telephone | 417-255-6883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CPM24080529
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License Number State | MO
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