Provider Demographics
NPI:1174258412
Name:SACRED DIVINE FEMININITY, LLC.
Entity Type:Organization
Organization Name:SACRED DIVINE FEMININITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNTA'
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLIAM-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BCNWP,CNHP,CD(DONA)
Authorized Official - Phone:814-460-3205
Mailing Address - Street 1:3612 BRANDES ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-3002
Mailing Address - Country:US
Mailing Address - Phone:814-460-3205
Mailing Address - Fax:
Practice Address - Street 1:4906 RICHMOND ST STE 6
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1978
Practice Address - Country:US
Practice Address - Phone:814-299-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing