Provider Demographics
NPI:1629843073
Name:WISCONSIN DOULAS OF COLOR COLLECTIVE INC
Entity Type:Organization
Organization Name:WISCONSIN DOULAS OF COLOR COLLECTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-213-7255
Mailing Address - Street 1:5301 W HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5019
Mailing Address - Country:US
Mailing Address - Phone:262-899-9245
Mailing Address - Fax:
Practice Address - Street 1:5301 W HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5019
Practice Address - Country:US
Practice Address - Phone:262-899-9245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty