MEDICARE: MS. LISA BETINA UNCLES CNM

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	RN1008706	DC

General Provider Information

NPI Number	:	1518039205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA BETINA UNCLES CNM

Provider Business Mailing Address
First Line	:	259 WAXTER WAY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-4142
Country	:	US
Telephone Number	:	202-398-5520
Fax Number	:	202-396-6953

Provider Business Practice Location Address
First Line	:	801 17TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7200
Country	:	US
Telephone Number	:	202-398-5520
Fax Number	:	202-396-6953

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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