Provider Demographics
NPI:1376980938
Name:WOMANS WELLNESS CENTER OF CONSHOHOCKEN LLC
Entity Type:Organization
Organization Name:WOMANS WELLNESS CENTER OF CONSHOHOCKEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:ECKERT
Authorized Official - Last Name:KUNASZUK
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:610-828-9683
Mailing Address - Street 1:1075 COLWELL LN
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-3206
Mailing Address - Country:US
Mailing Address - Phone:610-828-9683
Mailing Address - Fax:
Practice Address - Street 1:1075 COLWELL LN
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-3206
Practice Address - Country:US
Practice Address - Phone:610-828-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008408L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty