Provider Demographics
NPI:1306387154
Name:MIDWIVES RISING LLC
Entity type:Organization
Organization Name:MIDWIVES RISING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:602-242-4446
Mailing Address - Street 1:115 W MCDOWELL RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1383
Mailing Address - Country:US
Mailing Address - Phone:602-242-4446
Mailing Address - Fax:602-626-3555
Practice Address - Street 1:115 W MCDOWELL RD STE 4B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1383
Practice Address - Country:US
Practice Address - Phone:602-242-4446
Practice Address - Fax:602-626-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM148176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty