Provider Demographics
NPI:1538739875
Name:EDEN BIRTH AND WELLNESS
Entity type:Organization
Organization Name:EDEN BIRTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE-MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:PHEBE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GRANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNM
Authorized Official - Phone:479-573-8927
Mailing Address - Street 1:214 1ST ST
Mailing Address - Street 2:STE 203
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-7121
Mailing Address - Country:US
Mailing Address - Phone:479-573-8927
Mailing Address - Fax:
Practice Address - Street 1:219 LITTLE FLOCK DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-7121
Practice Address - Country:US
Practice Address - Phone:479-573-8927
Practice Address - Fax:866-441-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty