Organization
CREEKSIDE BIRTH COTTAGE
Active
Parent organization
CREEKSIDE MIDWIFERY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CREEKSIDE MIDWIFERY LLC
Authorized official
LACEY TACKETT (MEMBER)
(928) 951-6410
Entity
Organization
Contact information
Practice address
215 W FRONTIER ST, PAYSON, AZ 85541-5318
(928) 951-6410
Mailing address
215 W FRONTIER ST, PAYSON, AZ 85541-5318
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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