Provider Demographics
NPI:1861827057
Name:SANTA ROSA MIDWIFERY CENTER
Entity Type:Organization
Organization Name:SANTA ROSA MIDWIFERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:POINTER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:707-539-1544
Mailing Address - Street 1:4415 SONOMA HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4165
Mailing Address - Country:US
Mailing Address - Phone:707-539-1544
Mailing Address - Fax:707-539-0686
Practice Address - Street 1:4415 SONOMA HWY STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4165
Practice Address - Country:US
Practice Address - Phone:707-539-1544
Practice Address - Fax:707-539-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1382367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty