MEDICARE: MATERNAL INSTINCT DOULAS

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	305R00000X	Preferred Provider Organization	22616900	NY

General Provider Information

NPI Number	:	1104362938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATERNAL INSTINCT DOULAS

Provider Business Mailing Address
First Line	:	5720 METROVIEW PKWY
Second Line	:	278
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-1514
Country	:	US
Telephone Number	:	602-430-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	4899 UNDERWOOD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2126
Country	:	US
Telephone Number	:	602-430-2589
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. NANCY ANN BASKERVILLE
Credential	:	RN
Telephone Number	:	602-430-2589

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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Directions to “MATERNAL INSTINCT DOULAS ” Practice Location

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