MEDICARE: SACRED WATERS MIDWIFERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1902756588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED WATERS MIDWIFERY, LLC

Provider Business Mailing Address
First Line	:	7262 N CASSIE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3651
Country	:	US
Telephone Number	:	608-313-7180
Fax Number	:

Provider Business Practice Location Address
First Line	:	7262 N CASSIE AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3651
Country	:	US
Telephone Number	:	608-313-7180
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED NURSE MIDWIFE
Name	:	LATASHA S BROWN
Credential	:	CNM, APNP
Telephone Number	:	608-313-7180

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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