MEDICARE: MIKALA S BOOKS DOULA

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	:	1760026389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKALA S BOOKS DOULA

Provider Business Mailing Address
First Line	:	3217 20TH ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2311
Country	:	US
Telephone Number	:	779-771-4134
Fax Number	:

Provider Business Practice Location Address
First Line	:	3217 20TH ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61109-2311
Country	:	US
Telephone Number	:	779-771-4134
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ MIKALA S BOOKS DOULA” Practice Location

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