Provider Demographics
NPI:1740642297
Name:WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS
Entity type:Organization
Organization Name:WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM
Authorized Official - Phone:630-745-8937
Mailing Address - Street 1:4027 E CULLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 S VINEYARD
Practice Address - Street 2:SUITE 2E
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6889
Practice Address - Country:US
Practice Address - Phone:630-745-8937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing