Healthcare Provider Details

I. General information

NPI: 1659777894
Provider Name (Legal Business Name): TRILLIUM MIDWIFERY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 NEWTON AVE S
MINNEAPOLIS MN
55405-2036
US

IV. Provider business mailing address

32 NEWTON AVE S
MINNEAPOLIS MN
55405-2036
US

V. Phone/Fax

Practice location:
  • Phone: 612-298-2479
  • Fax: 888-831-1864
Mailing address:
  • Phone: 612-298-2479
  • Fax: 888-831-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1031
License Number StateMN

VIII. Authorized Official

Name: MS. EMME ELIZABETH CORBEIL
Title or Position: MIDWIFE
Credential: CPM, LM
Phone: 612-298-2479