MEDICARE: MRS. MARTHA PASCHKE CD(DONA)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1104187608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA PASCHKE CD(DONA)

Provider Business Mailing Address
First Line	:	227 N LINCOLN AVE
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-1216
Country	:	US
Telephone Number	:	633-232-4075
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 N LINCOLN AVE
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-1216
Country	:	US
Telephone Number	:	630-232-4075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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