Healthcare Provider Details

I. General information

NPI: 1346767894
Provider Name (Legal Business Name): MARCIA ELLEN MONTERROSO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA ELLEN SELL N/A

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-6963
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0454
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN223530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: