Provider Demographics
NPI:1689161069
Name:LONG PRAIRIE MIDWIVES, LLC
Entity Type:Organization
Organization Name:LONG PRAIRIE MIDWIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:320-304-3253
Mailing Address - Street 1:15125 COUNTY 38
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-4913
Mailing Address - Country:US
Mailing Address - Phone:320-732-8162
Mailing Address - Fax:320-732-8161
Practice Address - Street 1:13 2ND ST N
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1117
Practice Address - Country:US
Practice Address - Phone:320-732-8162
Practice Address - Fax:320-732-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty