Provider Demographics
NPI:1053777466
Name:SUPPORTING YOUR BIRTH, LLC
Entity type:Organization
Organization Name:SUPPORTING YOUR BIRTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:480-442-2294
Mailing Address - Street 1:2133 W SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1529
Mailing Address - Country:US
Mailing Address - Phone:480-442-2294
Mailing Address - Fax:
Practice Address - Street 1:2133 W SHARON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1529
Practice Address - Country:US
Practice Address - Phone:480-442-2294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM198176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty