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General NPI Number Information
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NPI Number | 1831472992
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Entity Type | Organization
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Legal Business Name | SACRED PASSAGE MIDWIFERY
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 57 NE 44TH ST
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City | MIAMI
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State | FL
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Zip | 33137-3413
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Country | US
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Telephone | 305-340-1189
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Fax |
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Provider Business Mailing Address
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Address Line | 57 NE 44TH ST
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City | MIAMI
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State | FL
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Zip | 33137-3413
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Country | US
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Telephone | 305-340-1189
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Fax |
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Authorized Official
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Title or Position | OWNER/MIDWIFE
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Name | LAMITSOI KHAILYLAH JORDAN
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Credential | LM
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Telephone | 305-340-1189
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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 | 246
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License Number State | FL
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