FOOTPRINTS IN TIME MIDWIFERY SERVICES LLC

Provider Demographics

• NPI: 1437438157
• Name: FOOTPRINTS IN TIME MIDWIFERY SERVICES LLC
• Entity Type: Organization
• Organization Name: FOOTPRINTS IN TIME MIDWIFERY SERVICES LLC
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: REBECCA
• Authorized Official - Middle Name: L
• Authorized Official - Last Name: AMBERG
• Authorized Official - Credentials: RN
• Authorized Official - Phone: 715-284-2003
• Mailing Address - Street 1: 502 MAIN ST
• Mailing Address - City: BLACK RIVER FALLS
• Mailing Address - State: WI
• Mailing Address - Zip Code: 54615-1648
• Mailing Address - Country: US
• Mailing Address - Phone: 715-284-2003
• Mailing Address - Fax: 715-284-2008
• Practice Address - Street 1: 502 MAIN ST
• Practice Address - City: BLACK RIVER FALLS
• Practice Address - State: WI
• Practice Address - Zip Code: 54615-1648
• Practice Address - Country: US
• Practice Address - Phone: 715-284-2003
• Practice Address - Fax: 844-285-4399
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2011-08-11
• Last Update Date: 2023-03-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center
No	261QB0400X	Ambulatory Health Care Facilities	Clinic/Center	Birthing

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	63651-30	Other	WI RN LICENSE
WI	147290-30	Other	REBECCA (BECKY) REGISTERED NURSE
WI	1689608010	Other	PATRICIA JACOBSON NPI
WI	992-33	Other	WI APNP LICENSE
	MJ0341963	Other	DEA - PATTY
	MJ0341963	Other	DEA - PATTY
WI	63651-30	Other	WI RN LICENSE
IA	B129556	Other	TERI G ADV. REGISTERED NURSE PRACTITIONER
WI	992-33	Other	WI APNP LICENSE
WI	148848-032	Other	TERI G CERTIFIED NURSE MIDWIFE
	CNM0142	Other	TERI AMERICAN MIDWIFERY CERTIFICATION BOARD
WI	4404-33	Other	TERI G ADV. PRACTICE NURSE PRSCRIBER
WI	1689608010	Other	PATRICIA JACOBSON NPI
WI	992-33	Other	WI APNP LICENSE