MEDICARE: ICAREDOULA CHILDBIRTH AND POSTPARTUM SERVICES

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	:	1639954068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICAREDOULA CHILDBIRTH AND POSTPARTUM SERVICES

Provider Business Mailing Address
First Line	:	155 WILLOWBROOK BLVD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	609-807-1758
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 WILLOWBROOK BLVD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7032
Country	:	US
Telephone Number	:	609-807-1758
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED BIRTH DOULA
Name	:	YASHEEN NILSA BRYANT
Credential	:	CD
Telephone Number	:	609-807-1758

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/25/2023

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