Healthcare Provider Details

I. General information

NPI: 1497391528
Provider Name (Legal Business Name): ASHLEY R GERAETS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 6TH AVE
WORTHINGTON MN
56187-2202
US

IV. Provider business mailing address

908 WHITE THUNDER CIR
LUVERNE MN
56156-1313
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-2941
  • Fax:
Mailing address:
  • Phone: 320-981-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number418
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: