Provider Demographics
NPI:1003452707
Name:DIVINE LOTUS DOULA AND WOMB CARE, LLC
Entity Type:Organization
Organization Name:DIVINE LOTUS DOULA AND WOMB CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-242-5368
Mailing Address - Street 1:2025 17TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4657
Mailing Address - Country:US
Mailing Address - Phone:941-242-5368
Mailing Address - Fax:
Practice Address - Street 1:2025 17TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4657
Practice Address - Country:US
Practice Address - Phone:941-242-5368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty