MEDICARE: SERENDIPITY MIDWIFERY, LLC

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	367A00000X	Advanced Practice Midwife	RN176291	GA

General Provider Information

NPI Number	:	1508238064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENDIPITY MIDWIFERY, LLC

Provider Business Mailing Address
First Line	:	6015 VALENCIA ST
Second Line	:
City	:	LAKE PARK
State	:	GA
Zip	:	31636-3457
Country	:	US
Telephone Number	:	229-834-7506
Fax Number	:	912-662-5413

Provider Business Practice Location Address
First Line	:	1011 WILLIAMS ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-4038
Country	:	US
Telephone Number	:	229-834-7506
Fax Number	:	912-662-5413

Authorized Official
Title or Position	:	CERTIFIED NURSE MIDWIFE/ OWNER
Name	:	LAUREN OSBORNE COURSON-BIBIN
Credential	:	CNM
Telephone Number	:	229-834-7506

Provider Enumeration Date	:	10/23/2015
Last Update Date	:	10/23/2015

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