Provider Demographics
NPI:1821457078
Name:MOREHEAD, ANANDA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:
Last Name:MOREHEAD
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 VALLEY EAST BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4630
Mailing Address - Country:US
Mailing Address - Phone:707-496-7417
Mailing Address - Fax:
Practice Address - Street 1:4677 VALLEY EAST BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4630
Practice Address - Country:US
Practice Address - Phone:707-496-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife