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General NPI Number Information
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NPI Number | 1467975490
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Entity Type | Individual
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Provider Name | JOANNA CLAIRE PUST TM, CPM, LM (WI)
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Gender | Female
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1367 TAFT ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-9315
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Country | US
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Telephone | 763-898-0925
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Fax | 763-312-2036
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Provider Business Mailing Address
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Address Line | 1367 TAFT ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-9315
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Country | US
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Telephone | 763-898-0925
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Fax | 763-312-2036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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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 | 273-49
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License Number State | WI
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