Healthcare Provider Details

I. General information

NPI: 1508490541
Provider Name (Legal Business Name): WILLOW MIDWIVES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E VETERANS MEMORIAL HWY STE 102
KASSON MN
55944-1716
US

IV. Provider business mailing address

11 E VETERANS MEMORIAL HWY STE 102
KASSON MN
55944-1716
US

V. Phone/Fax

Practice location:
  • Phone: 507-634-6071
  • Fax: 844-562-6828
Mailing address:
  • Phone: 507-634-6071
  • Fax: 844-562-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL A HEITKAMP
Title or Position: DIRECTOR
Credential:
Phone: 612-345-5920