=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801403399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY MARIE PEABODY CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2020
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2751 BAY PARK DR STE 300
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43616-4922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-690-7596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6224 STEEPLECHASE PKWY
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43571-9022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-467-0342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------