=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962329565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLINE FAST CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2026
-----------------------------------------------------
Last Update Date | 07/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2620 TUXEDO LN NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-453-5561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2620 TUXEDO LN NW
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-2365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-453-5561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | CNM11023
-----------------------------------------------------
License Number State |
-----------------------------------------------------