Healthcare Provider Details

I. General information

NPI: 1215341342
Provider Name (Legal Business Name): KAIROS MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16802 145TH AVE
MILACA MN
56353-3208
US

IV. Provider business mailing address

PO BOX 116
MILACA MN
56353-0116
US

V. Phone/Fax

Practice location:
  • Phone: 320-362-0476
  • Fax:
Mailing address:
  • Phone: 320-362-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1051
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number1051
License Number StateMN

VIII. Authorized Official

Name: MRS. DEBRA LYNN SAHLSTROM
Title or Position: MIDWIFE/OWNER
Credential: CPM, LM, RN
Phone: 320-362-0476