Healthcare Provider Details

I. General information

NPI: 1235609918
Provider Name (Legal Business Name): DRAGONFLY MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 02/19/2024
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 DAYTON AVE STE 316
SAINT PAUL MN
55104-6276
US

IV. Provider business mailing address

3035 BRYANT AVE S # 101
MINNEAPOLIS MN
55408-2828
US

V. Phone/Fax

Practice location:
  • Phone: 320-290-1496
  • Fax: 651-461-6690
Mailing address:
  • Phone: 320-290-1496
  • Fax: 651-461-6690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH TALBERT
Title or Position: OWNER
Credential: CPM, LTM
Phone: 320-290-1496