Provider Demographics
NPI:1265848493
Name:MIDTOWN NURSE MIDWIVES A NURSING CORPORATION
Entity Type:Organization
Organization Name:MIDTOWN NURSE MIDWIVES A NURSING CORPORATION
Other - Org Name:MIDTOWN LACTATION CONSULTANTS (MILC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:CERTA
Authorized Official - Last Name:SASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, IBCLC
Authorized Official - Phone:650-270-9387
Mailing Address - Street 1:2025 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5213
Mailing Address - Country:US
Mailing Address - Phone:916-936-2229
Mailing Address - Fax:916-307-4626
Practice Address - Street 1:2025 P ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5213
Practice Address - Country:US
Practice Address - Phone:916-936-2229
Practice Address - Fax:916-307-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605391163W00000X
163WL0100X
CA235738367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty