Healthcare Provider Details

I. General information

NPI: 1316071251
Provider Name (Legal Business Name): ALYSSA MARGARET FOLIN CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 GOODRICH AVE #2
SAINT PAUL MN
55105-3165
US

IV. Provider business mailing address

971 GOODRICH AVE #2
SAINT PAUL MN
55105
US

V. Phone/Fax

Practice location:
  • Phone: 651-587-7029
  • Fax:
Mailing address:
  • Phone: 651-587-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number1015
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: