Sophia Justine Henderson, LM, CPM
Individual provider Active NPI Midwife · Forestville, CA
NPI 1013342930 · NPPES record last updated Jul 13, 2021
Key facts
- NPI
- 1013342930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Midwife 176B00000X
- License
- 503 (CA)
- Practice address
- 7400 Malone Rd
Forestville, CA 95436-9597 - Phone
- (707) 529-8102
- NPI assigned
- Sep 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 503 | CA | Yes |
Addresses
Primary practice location
7400 Malone Rd
Forestville, CA 95436-9597
Mailing address
7400 Malone Road
Forestville, CA 95436-1066
Phone (707) 529-8102
Other names
- Sophia Justine Williams
Other providers in Forestville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.