Provider Demographics
NPI:1437568193
Name:WOMEN'S HEALTH COLLABORATIVE
Entity Type:Organization
Organization Name:WOMEN'S HEALTH COLLABORATIVE
Other - Org Name:THE CHILDBIRTH CENTER & WOMEN'S WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED NURSE-MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, MSN
Authorized Official - Phone:215-205-6758
Mailing Address - Street 1:716 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1645
Mailing Address - Country:US
Mailing Address - Phone:201-567-0810
Mailing Address - Fax:973-928-2912
Practice Address - Street 1:716 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:201-567-0810
Practice Address - Fax:973-928-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00056001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty