Provider Demographics
NPI:1407394547
Name:MIDWIFERY OF AUSTIN
Entity Type:Organization
Organization Name:MIDWIFERY OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:512-808-0038
Mailing Address - Street 1:2324 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4604
Mailing Address - Country:US
Mailing Address - Phone:512-808-0038
Mailing Address - Fax:512-717-5582
Practice Address - Street 1:5904 IDLEWOOD CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4048
Practice Address - Country:US
Practice Address - Phone:512-808-0038
Practice Address - Fax:512-717-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117626367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty