Healthcare Provider Details

I. General information

NPI: 1548689557
Provider Name (Legal Business Name): ANNA BOSCH CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA BARTELS

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 STEVENS AVE
MINNEAPOLIS MN
55409-2004
US

IV. Provider business mailing address

4234 STEVENS AVE
MINNEAPOLIS MN
55409-2004
US

V. Phone/Fax

Practice location:
  • Phone: 612-387-5618
  • Fax:
Mailing address:
  • Phone: 612-387-5618
  • 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: