Active NPI
Gwynavia Monique Scullark
- Doula
- Waterloo, IA
National Provider Identifier
1447985254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- License
- 1423959
- Practice address
- 442 Center St
Waterloo, IA 50703-3616 - Phone
- (319) 404-2630
- NPI assigned
- Jul 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | 1423959 | Primary |
Addresses
Primary practice location
442 Center St
Waterloo, IA 50703-3616
Mailing address
442 Center St
Waterloo, IA 50703-3616
Phone (319) 404-2630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1447985254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "442 CENTER ST",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507033616",
"telephone_number": "319-404-2630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 CENTER ST",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507033616",
"telephone_number": "319-404-2630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCULLARK",
"first_name": "GWYNAVIA",
"middle_name": "MONIQUE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-18",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": null,
"license": "1423959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.