Organization
FOOTPRINTS IN TIME MIDWIFERY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA L AMBERG RN (OWNER)
(715) 284-2003
Entity
Organization
Contact information
Practice address
502 MAIN ST, BLACK RIVER FALLS, WI 54615-1648
(715) 284-2003
(844) 285-4399
Mailing address
502 MAIN ST, BLACK RIVER FALLS, WI 54615-1648
(715) 284-2003
(715) 284-2008
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QB0400X
Birthing Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147290-30
REBECCA (BECKY) REGISTERED NURSE
WI
01
—
1689608010
PATRICIA JACOBSON NPI
WI
01
—
63651-30
WI RN LICENSE
WI
01
—
992-33
WI APNP LICENSE
WI
Enumeration date
08/11/2011
Last updated
03/07/2023
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