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General NPI Number Information
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NPI Number | 1821593187
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Entity Type | Organization
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Legal Business Name | MAIDEN TO MOTHER MIDWIFERY, LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 4431 NW 10TH ST
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1531
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Country | US
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Telephone | 954-404-3502
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Fax | 561-560-8852
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Provider Business Mailing Address
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Address Line | 4431 NW 10TH ST
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1531
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Country | US
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Telephone | 954-404-3502
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Fax | 954-337-2480
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH CHARRON
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Credential | LM, CPM
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Telephone | 954-404-3502
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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 | MW283
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License Number State | FL
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