Provider Demographics
NPI:1972932952
Name:BIRTHROOT MIDWIFERY LLC
Entity type:Organization
Organization Name:BIRTHROOT MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:MAE NAOMI
Authorized Official - Last Name:MASTRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:301-991-7414
Mailing Address - Street 1:PO BOX 1493
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-1493
Mailing Address - Country:US
Mailing Address - Phone:301-991-7414
Mailing Address - Fax:
Practice Address - Street 1:405 SWEETBRIAR RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-6943
Practice Address - Country:US
Practice Address - Phone:301-991-7414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty