1528767134 NPI number — HEAVENLY BLESSINGS MIDWIFERY LLC

Table of content: MS. SUSAN ELIZABETH WAY CNM (NPI 1558603480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528767134 NPI number — HEAVENLY BLESSINGS MIDWIFERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAVENLY BLESSINGS MIDWIFERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528767134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2614 PLEASANTVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63565-1467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2614 PLEASANTVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63565-1467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-342-0613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWFORD
Authorized Official First Name:
CAYLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
660-342-0613

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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