Provider Demographics
NPI:1962899880
Name:WHOLE HEART DOULA
Entity type:Organization
Organization Name:WHOLE HEART DOULA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED BIRTH DOULA
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:BAI CD
Authorized Official - Phone:903-335-4267
Mailing Address - Street 1:4264 COUNTY ROAD 4738
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-0941
Mailing Address - Country:US
Mailing Address - Phone:903-335-4267
Mailing Address - Fax:
Practice Address - Street 1:4264 COUNTY ROAD 4738
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-0941
Practice Address - Country:US
Practice Address - Phone:903-335-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBAICD4430374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBAICD4430OtherBAI