Healthcare Provider Details

I. General information

NPI: 1871608687
Provider Name (Legal Business Name): EDITH ANN WEISS-HOLZBAUER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 3RD ST SE
HURON SD
57350-2502
US

IV. Provider business mailing address

1637 ETNA ST
SAINT PAUL MN
55106-1210
US

V. Phone/Fax

Practice location:
  • Phone: 605-554-1020
  • Fax: 605-554-1021
Mailing address:
  • Phone: 612-709-3311
  • Fax: 612-709-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR 120054-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: