Healthcare Provider Details

I. General information

NPI: 1720601875
Provider Name (Legal Business Name): JOY MIDWIFERY AND WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 03/14/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 BAILEY RIDGE DR
WOODBURY MN
55125-8463
US

IV. Provider business mailing address

3549 BAILEY RIDGE DR
WOODBURY MN
55125-8463
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-0518
  • Fax:
Mailing address:
  • Phone: 917-470-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSANNAH 16163 IN OKUTORO-KETTER
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: MSN CNM
Phone: 917-470-0518