Individual
AUDRA JOY DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
R206041-7
MN
367A00000X
Advanced Practice Midwife
Primary
B161310
IA
367A00000X
Advanced Practice Midwife
CM000055
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6540373
—
SD
Enumeration date
02/21/2012
Last updated
02/09/2021
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