Provider Demographics
NPI:1073971271
Name:SIERRA HOMEBIRTH
Entity type:Organization
Organization Name:SIERRA HOMEBIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MELANYA
Authorized Official - Middle Name:EMELIA
Authorized Official - Last Name:GONSHOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:530-205-8742
Mailing Address - Street 1:10449 NO NAME DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4509
Mailing Address - Country:US
Mailing Address - Phone:530-205-8742
Mailing Address - Fax:
Practice Address - Street 1:10449 NO NAME DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4509
Practice Address - Country:US
Practice Address - Phone:530-205-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM336176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty