Healthcare Provider Details

I. General information

NPI: 1174247027
Provider Name (Legal Business Name): CORNELL FAYE ZBIKOWSKI CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EXCELSIOR BLVD STE 585
MINNEAPOLIS MN
55416-6400
US

IV. Provider business mailing address

110 E JOHNSON ST APT 3
MADISON WI
53703-3088
US

V. Phone/Fax

Practice location:
  • Phone: 608-444-3485
  • Fax:
Mailing address:
  • Phone: 608-444-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: