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General NPI Number Information
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NPI Number | 1689223356
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Entity Type | Individual
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Provider Name | BROOKE INEZ ELLINGSON EISCHENS APRN, CNM
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 968 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3014
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Country | US
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Telephone | 651-895-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 333 SIBLEY ST UNIT 305
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City | SAINT PAUL
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State | MN
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Zip | 55101-2689
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Country | US
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Telephone | 612-716-2751
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Fax |
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 9511-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 408
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License Number State | MN
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