Provider Demographics
NPI:1750771143
Name:WILLOW MIDWIVES LTD
Entity type:Organization
Organization Name:WILLOW MIDWIVES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:HEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-345-5920
Mailing Address - Street 1:3033 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 585
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4688
Mailing Address - Country:US
Mailing Address - Phone:612-345-5920
Mailing Address - Fax:844-562-6828
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 585
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4688
Practice Address - Country:US
Practice Address - Phone:612-345-5920
Practice Address - Fax:844-562-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1750771143Medicaid