Provider Demographics
NPI:1023426616
Name:WONDERFULLY MADE MIDWIFERY CARE, LLC
Entity type:Organization
Organization Name:WONDERFULLY MADE MIDWIFERY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:813-506-1823
Mailing Address - Street 1:7646 BULLS HEAD DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-7046
Mailing Address - Country:US
Mailing Address - Phone:813-506-1823
Mailing Address - Fax:
Practice Address - Street 1:7646 BULLS HEAD DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-7046
Practice Address - Country:US
Practice Address - Phone:813-506-1823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW278176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y0K9COtherFLORIDA BLUE PROVIDER NUMBER
Y0K9COtherFLORIDA BLUE PROVIDER NUMBER