Provider Demographics
NPI:1295541936
Name:MOON SISTERS MIDWIFERY LLC
Entity type:Organization
Organization Name:MOON SISTERS MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:503-341-6988
Mailing Address - Street 1:1735 ASH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2424
Mailing Address - Country:US
Mailing Address - Phone:503-341-6988
Mailing Address - Fax:503-894-6036
Practice Address - Street 1:2004 MAIN ST STE 313
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-7338
Practice Address - Country:US
Practice Address - Phone:503-341-6988
Practice Address - Fax:503-894-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care