Healthcare Provider Details

I. General information

NPI: 1902472798
Provider Name (Legal Business Name): EMPOWERED MIDWIFERY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 HAWTHORNE ST
ALEXANDRIA MN
56308-1815
US

IV. Provider business mailing address

22013 COUNTY ROAD 10
BARRETT MN
56311-1131
US

V. Phone/Fax

Practice location:
  • Phone: 320-335-1709
  • Fax:
Mailing address:
  • Phone: 320-335-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BRIMER
Title or Position: OWNER
Credential: APRN, CNM
Phone: 320-335-1709