MEDICARE: NEVADA COUNTY HOME BIRTH

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	176B00000X	Midwife	LM445	CA

General Provider Information

NPI Number	:	1508308230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA COUNTY HOME BIRTH

Provider Business Mailing Address
First Line	:	PO BOX 453
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-0453
Country	:	US
Telephone Number	:	530-477-1154
Fax Number	:	619-924-7165

Provider Business Practice Location Address
First Line	:	13267 GRUNT HILL RD
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-9474
Country	:	US
Telephone Number	:	530-477-1154
Fax Number	:	619-924-7165

Authorized Official
Title or Position	:	LICENSED MIDWIFE
Name	:	ARIANA COHEN
Credential	:	LM, CPM
Telephone Number	:	530-477-1154

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	11/11/2016

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Directions to “NEVADA COUNTY HOME BIRTH ” Practice Location

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