Provider Demographics
NPI:1407236219
Name:BREATH OF LIFE MIDWIFERY LLC
Entity type:Organization
Organization Name:BREATH OF LIFE MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:CPM LM
Authorized Official - Phone:540-676-7288
Mailing Address - Street 1:1917 FRANKLIN RD SW STE 102C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1133
Mailing Address - Country:US
Mailing Address - Phone:540-676-7288
Mailing Address - Fax:
Practice Address - Street 1:1917 FRANKLIN RD SW STE 102C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1133
Practice Address - Country:US
Practice Address - Phone:540-676-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000050176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty