Provider Demographics
NPI:1750655304
Name:HAYTKO, CAROL MICHELE (LABOR DOULA, CHILDBI)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MICHELE
Last Name:HAYTKO
Suffix:
Gender:F
Credentials:LABOR DOULA, CHILDBI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SOUTH MITCHELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3451
Mailing Address - Country:US
Mailing Address - Phone:215-527-2054
Mailing Address - Fax:
Practice Address - Street 1:640 SOUTH MITCHELL AVENUE
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3451
Practice Address - Country:US
Practice Address - Phone:215-527-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1092012489174H00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No376J00000XNursing Service Related ProvidersHomemaker