Provider Demographics
NPI:1457012973
Name:EVENSONG WOMEN'S HEALTH AND MIDWIFERY, LLC
Entity Type:Organization
Organization Name:EVENSONG WOMEN'S HEALTH AND MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:949-395-7336
Mailing Address - Street 1:1123 SAINT CROIX HTS
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1409
Mailing Address - Country:US
Mailing Address - Phone:949-395-7336
Mailing Address - Fax:
Practice Address - Street 1:1017 7TH ST S
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5703
Practice Address - Country:US
Practice Address - Phone:949-395-7336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty