MEDICARE: TINY MIRACLES DOULA SERVICES INC

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1720600836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY MIRACLES DOULA SERVICES INC

Provider Business Mailing Address
First Line	:	4160 N 39TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1664
Country	:	US
Telephone Number	:	414-687-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 W CAPITOL DR STE 212
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2156
Country	:	US
Telephone Number	:	414-763-3663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BIANCA RENEE WILLIAMS
Credential	:
Telephone Number	:	414-687-5731

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	12/09/2020

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