Provider Demographics
NPI:1194469445
Name:CREDLE, JANNIE M (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:M
Last Name:CREDLE
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TURNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3721
Mailing Address - Country:US
Mailing Address - Phone:757-774-7858
Mailing Address - Fax:
Practice Address - Street 1:300 TURNSTONE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3721
Practice Address - Country:US
Practice Address - Phone:757-774-7858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAJCR-105374374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula