Provider Demographics
NPI:1568811859
Name:MISSOULA DOULA
Entity Type:Organization
Organization Name:MISSOULA DOULA
Other - Org Name:MISSOULA DOULA BIRTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RMA, CBD, TC
Authorized Official - Phone:406-207-3900
Mailing Address - Street 1:9280 SHARPTAIL DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1002
Mailing Address - Country:US
Mailing Address - Phone:406-207-3900
Mailing Address - Fax:
Practice Address - Street 1:9280 SHARPTAIL DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1002
Practice Address - Country:US
Practice Address - Phone:406-207-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty