Provider Demographics
NPI:1588935225
Name:LAUGHING WATERS HOMEBIRTH MIDWIFERY
Entity type:Organization
Organization Name:LAUGHING WATERS HOMEBIRTH MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HAYDEN-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:605-351-8041
Mailing Address - Street 1:1417 S SEVERN LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3320
Mailing Address - Country:US
Mailing Address - Phone:605-351-8041
Mailing Address - Fax:605-370-6801
Practice Address - Street 1:1417 S SEVERN LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3320
Practice Address - Country:US
Practice Address - Phone:605-351-8041
Practice Address - Fax:605-370-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCM000048367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6540360Medicaid