Provider Demographics
NPI:1104362938
Name:MATERNAL INSTINCT DOULAS
Entity type:Organization
Organization Name:MATERNAL INSTINCT DOULAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-430-2589
Mailing Address - Street 1:5720 METROVIEW PKWY
Mailing Address - Street 2:278
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1514
Mailing Address - Country:US
Mailing Address - Phone:602-430-2589
Mailing Address - Fax:
Practice Address - Street 1:4899 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2126
Practice Address - Country:US
Practice Address - Phone:602-430-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22616900305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization