Provider Demographics
NPI:1508238064
Name:SERENDIPITY MIDWIFERY, LLC
Entity Type:Organization
Organization Name:SERENDIPITY MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:OSBORNE
Authorized Official - Last Name:COURSON-BIBIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:229-834-7506
Mailing Address - Street 1:6015 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-3457
Mailing Address - Country:US
Mailing Address - Phone:229-834-7506
Mailing Address - Fax:912-662-5413
Practice Address - Street 1:1011 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4038
Practice Address - Country:US
Practice Address - Phone:229-834-7506
Practice Address - Fax:912-662-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176291367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty