Provider Demographics
NPI:1114281227
Name:SAHLSTROM, DEBRA LYNN (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:SAHLSTROM
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12390 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-5801
Mailing Address - Country:US
Mailing Address - Phone:320-362-0476
Mailing Address - Fax:320-983-5444
Practice Address - Street 1:16802 145TH AVE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-3208
Practice Address - Country:US
Practice Address - Phone:320-983-2999
Practice Address - Fax:320-983-2998
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1051176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife