Provider Demographics
NPI:1255507166
Name:FOX, DANA (LM)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 GRAVENSTEIN HWY S
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4841
Mailing Address - Country:US
Mailing Address - Phone:707-829-5094
Mailing Address - Fax:707-829-5094
Practice Address - Street 1:1838 GRAVENSTEIN HWY S
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4841
Practice Address - Country:US
Practice Address - Phone:707-829-5094
Practice Address - Fax:707-829-5094
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM83176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife