Provider Demographics
NPI:1821354986
Name:NORTHCROSS, MAEVE (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:MAEVE
Middle Name:
Last Name:NORTHCROSS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:MS
Other - First Name:JENEE
Other - Middle Name:MARLEEN
Other - Last Name:OHRVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:9804 MCFARRING DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5898
Mailing Address - Country:US
Mailing Address - Phone:817-629-0722
Mailing Address - Fax:512-870-9232
Practice Address - Street 1:9804 MCFARRING DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5898
Practice Address - Country:US
Practice Address - Phone:817-629-0722
Practice Address - Fax:512-870-9232
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99148176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife