Provider Demographics
NPI:1760870943
Name:JUNE MOON HOME BIRTH
Entity Type:Organization
Organization Name:JUNE MOON HOME BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPREAU
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:651-239-3895
Mailing Address - Street 1:2105 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2319
Mailing Address - Country:US
Mailing Address - Phone:651-239-3895
Mailing Address - Fax:
Practice Address - Street 1:2105 8TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2319
Practice Address - Country:US
Practice Address - Phone:651-239-3895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty