Provider Demographics
NPI:1659091049
Name:MEYER, CAROLINE ELIZABETH (CPM)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:C
Other - Middle Name:ELIZABETH
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:BROOTEN
Mailing Address - State:MN
Mailing Address - Zip Code:56316
Mailing Address - Country:US
Mailing Address - Phone:320-444-8838
Mailing Address - Fax:
Practice Address - Street 1:501 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:BROOTEN
Practice Address - State:MN
Practice Address - Zip Code:56316
Practice Address - Country:US
Practice Address - Phone:320-444-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22040006176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife