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General NPI Number Information
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NPI Number | 1972322758
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Entity Type | Organization
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Legal Business Name | MOTHER OF LIFE DOULA
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 324 17TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-6618
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Country | US
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Telephone | 202-607-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 324 17TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-6618
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Country | US
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Telephone | 202-607-9765
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS BONITA TIFFANY WALL
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Credential |
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Telephone | 202-607-9765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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