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General NPI Number Information
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NPI Number | 1770481806
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Entity Type | Organization
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Legal Business Name | TIDAL WATERS MIDWIFERY LLC
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Dates
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Enumeration Date | 10/28/2026
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Last Update Date | 10/28/2026
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Provider Practice Location Address
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Address Line | 352 THORNTOWN RD
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City | MIDDLETOWN
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State | DE
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Zip | 19709-9442
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Country | US
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Telephone | 302-884-2003
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Fax | 302-400-3704
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Provider Business Mailing Address
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Address Line | 352 THORNTOWN RD
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City | MIDDLETOWN
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State | DE
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Zip | 19709-9442
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Country | US
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Telephone | 302-884-2003
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Fax | 302-400-3704
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN RENEE KEYLICH
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Credential | CPM
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Telephone | 302-884-2003
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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 |
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License Number State |
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