MEDICARE: MRS. KWAJALEIN RONTOYA CLEVELAND 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	CNM04165

General Provider Information

NPI Number	:	1740793652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KWAJALEIN RONTOYA CLEVELAND CNM

Provider Business Mailing Address
First Line	:	2952 NANTUCKETT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8901
Country	:	US
Telephone Number	:	843-729-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1165
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2235
Country	:	US
Telephone Number	:	404-223-9306
Fax Number	:	404-223-9307

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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