Healthcare Provider Details

I. General information

NPI: 1801299128
Provider Name (Legal Business Name): WILLOW MIDWIVES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 EXCELSIOR BLVD SUITE 585
MINNEAPOLIS MN
55416-4688
US

IV. Provider business mailing address

3033 EXCELSIOR BLVD STE 585
MINNEAPOLIS MN
55416-6400
US

V. Phone/Fax

Practice location:
  • Phone: 952-212-6801
  • Fax:
Mailing address:
  • Phone: 612-345-5920
  • Fax: 844-562-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number31316
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANDERSON HEITKAMP
Title or Position: PRESIDENT
Credential:
Phone: 612-345-5920