Provider Demographics
NPI:1821850371
Name:TIDAL DOULA LLC
Entity Type:Organization
Organization Name:TIDAL DOULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:KOSSILA HAUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-647-0461
Mailing Address - Street 1:3216 DREW AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3250
Mailing Address - Country:US
Mailing Address - Phone:763-647-0461
Mailing Address - Fax:
Practice Address - Street 1:3216 DREW AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-3250
Practice Address - Country:US
Practice Address - Phone:763-647-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty