Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1051 | MN |
NPI | 1114281227 |
---|---|
Provider Name | Mrs. Debra Lynn Sahlstrom |
First Address | Milaca, MN 56353-5801 |
Second Address | Milaca, MN 56353-3208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2012 |
Last Update Date | 14/01/2016 |