Healthcare Provider Details

I. General information

NPI: 1114843612
Provider Name (Legal Business Name): SOUTHSIDE MIDWIFERY COLLECTIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 ELLIOT AVE
MINNEAPOLIS MN
55407-2127
US

IV. Provider business mailing address

PO BOX 7438
MINNEAPOLIS MN
55407-0438
US

V. Phone/Fax

Practice location:
  • Phone: 612-424-3174
  • Fax:
Mailing address:
  • Phone: 612-424-3174
  • Fax: 612-500-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA FRICKE
Title or Position: CERTIFIED NURSE MIDIWFE
Credential: CNM
Phone: 719-580-9134