Provider Demographics
NPI:1871003525
Name:GAIA MIDWIVES PLLC
Entity Type:Organization
Organization Name:GAIA MIDWIVES PLLC
Other - Org Name:GAIA MIDWIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HEINZE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:423-505-2056
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0405
Mailing Address - Country:US
Mailing Address - Phone:631-486-0832
Mailing Address - Fax:631-504-0723
Practice Address - Street 1:90 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1038
Practice Address - Country:US
Practice Address - Phone:631-486-0832
Practice Address - Fax:631-504-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001814367A00000X
NY001788367A00000X
NY001393367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty