Provider Demographics
NPI:1265121487
Name:KERWIN, STEPHANIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KERWIN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 PACHECO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1319
Mailing Address - Country:US
Mailing Address - Phone:831-682-6763
Mailing Address - Fax:
Practice Address - Street 1:633 PACHECO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1319
Practice Address - Country:US
Practice Address - Phone:831-682-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife