Provider Demographics
NPI:1275016305
Name:BREATHE BIRTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:BREATHE BIRTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MIDWIFE PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNM, DNP
Authorized Official - Phone:918-250-2229
Mailing Address - Street 1:4800 W SAN ANTONIO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6127
Mailing Address - Country:US
Mailing Address - Phone:918-250-2229
Mailing Address - Fax:918-250-2232
Practice Address - Street 1:4800 W SAN ANTONIO ST STE 101
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6127
Practice Address - Country:US
Practice Address - Phone:918-250-2229
Practice Address - Fax:918-250-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578062436OtherNATIONAL PROVIDER IDENTIFIER