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General NPI Number Information
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NPI Number | 1295287142
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Entity Type | Organization
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Legal Business Name | BRAINERD LAKES MIDWIFERY LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 1001 KINGWOOD ST STE 121
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City | BRAINERD
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State | MN
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Zip | 56401-3400
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Country | US
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Telephone | 218-454-0909
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Fax | 218-260-4321
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Provider Business Mailing Address
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Address Line | 1001 KINGWOOD ST STE 121
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City | BRAINERD
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State | MN
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Zip | 56401-3400
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Country | US
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Telephone | 218-454-0909
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Fax | 218-260-4321
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Authorized Official
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Title or Position | LICENSED MIDWIFE
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Name | MS. SONYA KATHERINE HESS CHAMBERLAIN
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Credential | LM, CPM
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Telephone | 218-454-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 1039
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License Number State | MN
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