Provider Demographics
NPI:1295287142
Name:BRAINERD LAKES MIDWIFERY LLC
Entity type:Organization
Organization Name:BRAINERD LAKES MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:KATHERINE HESS
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:218-454-0909
Mailing Address - Street 1:1001 KINGWOOD ST STE 121
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3400
Mailing Address - Country:US
Mailing Address - Phone:218-454-0909
Mailing Address - Fax:218-260-4321
Practice Address - Street 1:1001 KINGWOOD ST STE 121
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3400
Practice Address - Country:US
Practice Address - Phone:218-454-0909
Practice Address - Fax:218-260-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1039176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1730415720OtherINDIVIDUAL PRACTITIONER NPI
MN1039OtherMN BOARD OF MEDICAL PRACTICE LICENSE NUMBER