Provider Demographics
NPI:1316785199
Name:MERCY MIDWIFERY & WOMEN'S HEALTH, PLLC
Entity type:Organization
Organization Name:MERCY MIDWIFERY & WOMEN'S HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:757-362-1548
Mailing Address - Street 1:1520 TERRA VISTA DR APT 651
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4892
Mailing Address - Country:US
Mailing Address - Phone:757-362-1548
Mailing Address - Fax:
Practice Address - Street 1:1520 TERRA VISTA DR APT 651
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4892
Practice Address - Country:US
Practice Address - Phone:757-362-1548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center