Healthcare Provider Details

I. General information

NPI: 1487243861
Provider Name (Legal Business Name): GRACE HONDERICH FLANNERY CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 WALTON OAKS DR
BLOOMINGTON MN
55438-1353
US

IV. Provider business mailing address

8781 WALTON OAKS DR
BLOOMINGTON MN
55438-1353
US

V. Phone/Fax

Practice location:
  • Phone: 612-986-7994
  • Fax: 888-831-1864
Mailing address:
  • Phone: 612-986-7994
  • Fax: 888-831-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1084
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: