MEDICARE: MRS. SARAH PRETTEL 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	:	1982050076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH PRETTEL DOULA

Provider Business Mailing Address
First Line	:	4110 WILLIAM FLEMING CT APT G
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1167
Country	:	US
Telephone Number	:	817-719-6638
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 WILLIAM FLEMING CT APT G
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1167
Country	:	US
Telephone Number	:	817-719-6638
Fax Number	:

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

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/09/2016

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