=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346658150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRILLIUM MIDWIFERY SERVICES LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2014
-----------------------------------------------------
Last Update Date | 03/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1109 WISCONSIN AVE
-----------------------------------------------------
City | BOSCOBEL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53805-1636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-736-2229
-----------------------------------------------------
Fax | 608-492-3524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1109 WISCONSIN AVE
-----------------------------------------------------
City | BOSCOBEL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53805-1636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-736-2229
-----------------------------------------------------
Fax | 608-492-3524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | HEATHER KRAMER
-----------------------------------------------------
Credential | RN, CPM, LM
-----------------------------------------------------
Telephone | 608-306-0147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------