Healthcare Provider Details

I. General information

NPI: 1740861541
Provider Name (Legal Business Name): GRACE SHELBY BUEZIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 HAZELWOOD ST STE 100
MAPLEWOOD MN
55109-1242
US

IV. Provider business mailing address

2809 OLIVE HWY STE 310
OROVILLE CA
95966-6135
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-7800
  • Fax:
Mailing address:
  • Phone: 530-533-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number638
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: