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General NPI Number Information
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NPI Number | 1437438157
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Entity Type | Organization
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Legal Business Name | FOOTPRINTS IN TIME MIDWIFERY SERVICES LLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 502 MAIN ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-1648
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Country | US
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Telephone | 715-284-2003
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Fax | 844-285-4399
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Provider Business Mailing Address
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Address Line | 502 MAIN ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-1648
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Country | US
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Telephone | 715-284-2003
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Fax | 715-284-2008
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA L AMBERG
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Credential | RN
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Telephone | 715-284-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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