MEDICARE: KATIE ROSS IRELAND BSN, CNM

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	367A00000X	Advanced Practice Midwife	R 144301-9	MN

General Provider Information

NPI Number	:	1235545310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ROSS IRELAND BSN, CNM

Provider Business Mailing Address
First Line	:	2603 WHITE BEAR AVE N
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5110
Country	:	US
Telephone Number	:	651-600-3035
Fax Number	:	651-348-8783

Provider Business Practice Location Address
First Line	:	3620 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2712
Country	:	US
Telephone Number	:	952-451-3085
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	11/22/2021

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