MEDICARE: ARIANA LISSELLE KNUDSON DOULA

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	:	1447036835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIANA LISSELLE KNUDSON DOULA

Provider Business Mailing Address
First Line	:	19811 E 47TH TERRACE CT
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-9740
Country	:	US
Telephone Number	:	864-707-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	19811 E 47TH TERRACE CT
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-9740
Country	:	US
Telephone Number	:	864-707-6959
Fax Number	:

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

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	09/01/2023

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