Provider Demographics
NPI:1063653004
Name:FRUITFULVINE MIDWIFERY CARE,LP
Entity Type:Organization
Organization Name:FRUITFULVINE MIDWIFERY CARE,LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NATAIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WOMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, LM, CPM
Authorized Official - Phone:713-376-0163
Mailing Address - Street 1:9011 SOLARA BEND CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5094
Mailing Address - Country:US
Mailing Address - Phone:713-376-0163
Mailing Address - Fax:281-313-5527
Practice Address - Street 1:9011 SOLARA BEND CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5094
Practice Address - Country:US
Practice Address - Phone:713-376-0163
Practice Address - Fax:281-313-5527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMMACK FAMILY ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05017176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty