Provider Demographics
NPI:1235478611
Name:WILLOWSONG MIDWIFERY CARE
Entity Type:Organization
Organization Name:WILLOWSONG MIDWIFERY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:COSETTE
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ARNP, CNM
Authorized Official - Phone:515-266-6712
Mailing Address - Street 1:733 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1039
Mailing Address - Country:US
Mailing Address - Phone:515-266-6712
Mailing Address - Fax:515-244-2333
Practice Address - Street 1:733 19TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1039
Practice Address - Country:US
Practice Address - Phone:515-266-6712
Practice Address - Fax:515-244-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAB-100222367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty