Provider Demographics
NPI:1497142947
Name:TRANQUIL MOMENTS DOULA
Entity Type:Organization
Organization Name:TRANQUIL MOMENTS DOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER, BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:ICD
Authorized Official - Phone:515-201-7139
Mailing Address - Street 1:327 SCANDIA AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-3659
Mailing Address - Country:US
Mailing Address - Phone:515-201-7139
Mailing Address - Fax:
Practice Address - Street 1:327 SCANDIA AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-3659
Practice Address - Country:US
Practice Address - Phone:515-201-7139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA489292374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty