Provider Demographics
NPI:1295366110
Name:NURTURED BIRTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:NURTURED BIRTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KARLEEN
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:CDM, CPM
Authorized Official - Phone:907-299-7140
Mailing Address - Street 1:855 SAND DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8818
Mailing Address - Country:US
Mailing Address - Phone:907-299-7140
Mailing Address - Fax:833-709-5742
Practice Address - Street 1:855 SAND DOLLAR DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8818
Practice Address - Country:US
Practice Address - Phone:907-299-7140
Practice Address - Fax:833-709-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty