Provider Demographics
NPI:1861706087
Name:WHBC MIDWIVES, INC., A NURSING CORPORATION
Entity type:Organization
Organization Name:WHBC MIDWIVES, INC., A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:NYDAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNM
Authorized Official - Phone:707-539-1544
Mailing Address - Street 1:583 SUMMERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5239
Mailing Address - Country:US
Mailing Address - Phone:707-539-1544
Mailing Address - Fax:
Practice Address - Street 1:583 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5239
Practice Address - Country:US
Practice Address - Phone:707-539-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3306897367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty