Provider Demographics
NPI:1295162014
Name:JESSICA HULDERMAN DOULA
Entity type:Organization
Organization Name:JESSICA HULDERMAN DOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HULDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPD
Authorized Official - Phone:419-704-8105
Mailing Address - Street 1:52 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3632
Mailing Address - Country:US
Mailing Address - Phone:419-704-8105
Mailing Address - Fax:
Practice Address - Street 1:52 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-3632
Practice Address - Country:US
Practice Address - Phone:419-704-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty