MEDICARE: ZINAJAH JORENE EULALIE PROVIDENCE- WHITE

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		CO

General Provider Information

NPI Number	:	1598434078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZINAJAH JORENE EULALIE PROVIDENCE- WHITE

Provider Business Mailing Address
First Line	:	5755 PALE ROCK TER APT G
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2318
Country	:	US
Telephone Number	:	929-228-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 PALE ROCK TER APT G
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2318
Country	:	US
Telephone Number	:	929-228-6056
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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