MEDICARE: VANESSA COLDWATER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife
2	176B00000X	Midwife

General Provider Information

NPI Number	:	1003055328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA COLDWATER

Provider Business Mailing Address
First Line	:	2150 KNAPP ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1813
Country	:	US
Telephone Number	:	612-747-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 KNAPP ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1813
Country	:	US
Telephone Number	:	612-747-9096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	01/18/2024

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Directions to “ VANESSA COLDWATER ” Practice Location

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