Healthcare Provider Details

I. General information

NPI: 1326183732
Provider Name (Legal Business Name): HEARTFELT MIDWIFERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 2ND ST ROOM 108
WINONA MN
55987-3440
US

IV. Provider business mailing address

50 W 2ND ST ROOM 108
WINONA MN
55987-3440
US

V. Phone/Fax

Practice location:
  • Phone: 507-474-0233
  • Fax:
Mailing address:
  • Phone: 507-474-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1016
License Number StateMN

VIII. Authorized Official

Name: MS. TANYA ELISE MUDRICK
Title or Position: CHIEF MANAGER
Credential: C.P.M., L.T.M., L.M.
Phone: 507-474-0233