Provider Demographics
NPI:1508490541
Name:WILLOW MIDWIVES LTD
Entity Type:Organization
Organization Name:WILLOW MIDWIVES LTD
Other - Org Name:FULL CIRCLE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-345-5920
Mailing Address - Street 1:11 E VETERANS MEMORIAL HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-1716
Mailing Address - Country:US
Mailing Address - Phone:507-634-6071
Mailing Address - Fax:844-562-6828
Practice Address - Street 1:11 E VETERANS MEMORIAL HWY STE 102
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-1716
Practice Address - Country:US
Practice Address - Phone:507-634-6071
Practice Address - Fax:844-562-6828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW MIDWIVES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health