Provider Demographics
NPI:1699395863
Name:GREEN BAY DOULAS, LLC
Entity Type:Organization
Organization Name:GREEN BAY DOULAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CERTIFIED DOULA
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-246-0200
Mailing Address - Street 1:PO BOX 1851
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1851
Mailing Address - Country:US
Mailing Address - Phone:920-246-0200
Mailing Address - Fax:
Practice Address - Street 1:437 S JACKSON ST RM 130
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3909
Practice Address - Country:US
Practice Address - Phone:920-246-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty