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General NPI Number Information
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NPI Number | 1215341342
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Entity Type | Organization
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Legal Business Name | KAIROS MIDWIFERY
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 16802 145TH AVE
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City | MILACA
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State | MN
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Zip | 56353-3208
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Country | US
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Telephone | 320-362-0476
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 116
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City | MILACA
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State | MN
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Zip | 56353-0116
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Country | US
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Telephone | 320-362-0476
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Fax |
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Authorized Official
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Title or Position | MIDWIFE/OWNER
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Name | MRS. DEBRA LYNN SAHLSTROM
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Credential | CPM, LM, RN
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Telephone | 320-362-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | 1051
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 1051
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License Number State | MN
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