Provider Demographics
NPI:1144617341
Name:INDIE MOON DOULA SERVICES
Entity Type:Organization
Organization Name:INDIE MOON DOULA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:FRANTZ-VOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CBD (BAI)
Authorized Official - Phone:307-259-6211
Mailing Address - Street 1:189 HONEYSUCKLE ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4041
Mailing Address - Country:US
Mailing Address - Phone:307-259-6211
Mailing Address - Fax:
Practice Address - Street 1:189 HONEYSUCKLE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4041
Practice Address - Country:US
Practice Address - Phone:307-259-6211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty