Provider Demographics
NPI:1225824030
Name:MYSTIC WATERS LLC
Entity type:Organization
Organization Name:MYSTIC WATERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:760-815-6923
Mailing Address - Street 1:14523 RIDGETOP TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1037
Mailing Address - Country:US
Mailing Address - Phone:760-815-6923
Mailing Address - Fax:
Practice Address - Street 1:14523 RIDGETOP TER
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1037
Practice Address - Country:US
Practice Address - Phone:760-815-6923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty