Provider Demographics
NPI:1679104962
Name:BIRTHING TRADITIONS, LLC
Entity Type:Organization
Organization Name:BIRTHING TRADITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:307-202-2386
Mailing Address - Street 1:751 ROAD 11
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9131
Mailing Address - Country:US
Mailing Address - Phone:307-202-2386
Mailing Address - Fax:
Practice Address - Street 1:751 ROAD 11
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9131
Practice Address - Country:US
Practice Address - Phone:307-202-2386
Practice Address - Fax:307-754-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing