Provider Demographics
NPI:1659029890
Name:SOUTHWARD, EMILIE ANN
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:ANN
Last Name:SOUTHWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7266 BLACKTON DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7560
Mailing Address - Country:US
Mailing Address - Phone:805-714-5175
Mailing Address - Fax:
Practice Address - Street 1:7266 BLACKTON DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7560
Practice Address - Country:US
Practice Address - Phone:805-714-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12773374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula