Healthcare Provider Details

I. General information

NPI: 1750813044
Provider Name (Legal Business Name): RACHEL STAPLETON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 GRAND AVE
SAINT PAUL MN
55105-3014
US

IV. Provider business mailing address

1117 W FRANKLIN AVE #204
MINNEAPOLIS MN
55405-3166
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-2520
  • Fax:
Mailing address:
  • Phone: 952-484-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1061
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: