Healthcare Provider Details

I. General information

NPI: 1326652256
Provider Name (Legal Business Name): AMY REBECCA HURST CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY REBECCA TUTEWOHL

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 SMITH AVE N STE 203
SAINT PAUL MN
55102-2388
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-7733
  • Fax:
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number444
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: