Healthcare Provider Details

I. General information

NPI: 1811780679
Provider Name (Legal Business Name): TARA RAE SCHWANDT CNM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 FRANCE AVE S STE 100
EDINA MN
55435-2158
US

IV. Provider business mailing address

6525 FRANCE AVE S STE 100
EDINA MN
55435-2158
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7111
  • Fax:
Mailing address:
  • Phone: 612-273-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number629
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: