Provider Demographics
NPI:1831643337
Name:MANDALA MIDWIFERY LLC
Entity type:Organization
Organization Name:MANDALA MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:541-647-1788
Mailing Address - Street 1:63030 COLE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9564
Mailing Address - Country:US
Mailing Address - Phone:541-647-1788
Mailing Address - Fax:541-205-4885
Practice Address - Street 1:63030 COLE RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9564
Practice Address - Country:US
Practice Address - Phone:541-647-1788
Practice Address - Fax:541-205-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty