Organization
COUNTRY MIDWIFE LLC
Active
Other names
Country Midwife
Organization subpart
No
Provider details
NPI number
Authorized official
MISS STACY L VANDENPUT LM, CPM (MIDWIFE, MANAGER)
(920) 562-9058
Entity
Organization
Contact information
Practice address
1638 DECKNER AVE, SUITE A, GREEN BAY, WI 54302-2640
(920) 562-9058
Mailing address
1638 DECKNER AVE, SUITE A, GREEN BAY, WI 54302-2640
(920) 562-9058
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
163WH0200X
Home Health Registered Nurse
—
—
163WL0100X
Lactation Consultant (Registered Nurse)
—
—
163WM0102X
Maternal Newborn Registered Nurse
—
—
163WW0101X
Ambulatory Women's Health Care Registered Nurse
—
—
176B00000X
Midwife
31-049
WI
176B00000X
Midwife
—
WI
176B00000X
Midwife
—
—
261QB0400X
Birthing Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
367A00000X
Advanced Practice Midwife
Primary
107888-030
WI
Other
Enumeration date
04/17/2008
Last updated
11/05/2010
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