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General NPI Number Information
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NPI Number | 1891161188
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Entity Type | Organization
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Legal Business Name | GENTLE HARBOR MIDWIFERY
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 1793 NEWMAN TER
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City | BENTON HARBOR
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State | MI
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Zip | 49022-6532
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Country | US
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Telephone | 269-470-2611
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Fax |
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Provider Business Mailing Address
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Address Line | 1793 NEWMAN TER
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City | BENTON HARBOR
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State | MI
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Zip | 49022-6532
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Country | US
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Telephone | 269-470-2611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRIE SUE LENLEY
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Credential | CNM
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Telephone | 269-470-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State | MI
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