MEDICARE: A MONARCH BIRTH, LLC

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	374J00000X	Doula

General Provider Information

NPI Number	:	1407207202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A MONARCH BIRTH, LLC

Provider Business Mailing Address
First Line	:	1937 ALDRICH AVE S
Second Line	:	12
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3103
Country	:	US
Telephone Number	:	612-718-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1937 ALDRICH AVE S
Second Line	:	12
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3103
Country	:	US
Telephone Number	:	612-718-7004
Fax Number	:

Authorized Official
Title or Position	:	BIRTH DOULA
Name	:	ALICIA KORNACKER
Credential	:
Telephone Number	:	612-718-7004

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	06/23/2016

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