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General NPI Number Information
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NPI Number | 1922149996
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Entity Type | Organization
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Legal Business Name | HERITAGE MIDWIFERY LLC
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6336 55TH AVE
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City | PRINCETON
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State | MN
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Zip | 55371-6423
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Country | US
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Telephone | 612-245-1887
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Fax | 763-389-8316
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Provider Business Mailing Address
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Address Line | 6336 55TH AVE
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City | PRINCETON
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State | MN
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Zip | 55371-6423
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Country | US
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Telephone | 612-245-1887
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Fax | 763-389-8316
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAUREEN C DAHL
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Credential | CPM, LM
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Telephone | 612-245-1887
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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 | 1014
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License Number State | MN
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