Provider Demographics
NPI:1205671104
Name:LE GRA BIRTH SERVICES, LLC
Entity type:Organization
Organization Name:LE GRA BIRTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:BRIEANA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:951-397-6264
Mailing Address - Street 1:1885 HOWARD ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4844
Mailing Address - Country:US
Mailing Address - Phone:951-397-6264
Mailing Address - Fax:
Practice Address - Street 1:1885 HOWARD ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4844
Practice Address - Country:US
Practice Address - Phone:951-397-6264
Practice Address - Fax:651-447-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty