Provider Demographics
NPI:1548147440
Name:OVER THE MOON MIDWIFERY
Entity type:Organization
Organization Name:OVER THE MOON MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM, MS RD
Authorized Official - Phone:402-850-7644
Mailing Address - Street 1:731 W SIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-8333
Mailing Address - Country:US
Mailing Address - Phone:402-850-7644
Mailing Address - Fax:602-894-0494
Practice Address - Street 1:731 W SIESTA WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-8333
Practice Address - Country:US
Practice Address - Phone:602-641-6734
Practice Address - Fax:602-894-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty