Provider Demographics
NPI:1437390523
Name:FULL CIRCLE WOMEN'S HEALTH AND BIRTH
Entity type:Organization
Organization Name:FULL CIRCLE WOMEN'S HEALTH AND BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:713-569-5997
Mailing Address - Street 1:1961 W FARRAGUT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1382
Mailing Address - Country:US
Mailing Address - Phone:713-569-5997
Mailing Address - Fax:
Practice Address - Street 1:1961 W FARRAGUT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1382
Practice Address - Country:US
Practice Address - Phone:713-569-5997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006855367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty