Provider Demographics
NPI:1972207868
Name:THE BIRTH TRIBE LLC
Entity Type:Organization
Organization Name:THE BIRTH TRIBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNALYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:CD-L, IBCLC
Authorized Official - Phone:725-260-4911
Mailing Address - Street 1:8179 PALACE MONACO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2569
Mailing Address - Country:US
Mailing Address - Phone:725-260-4911
Mailing Address - Fax:
Practice Address - Street 1:8179 PALACE MONACO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2569
Practice Address - Country:US
Practice Address - Phone:725-260-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407509441OtherNPI 1