Provider Demographics
NPI:1487243861
Name:FLANNERY, GRACE HONDERICH (CPM, LM)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HONDERICH
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4182
Mailing Address - Country:US
Mailing Address - Phone:612-986-7994
Mailing Address - Fax:
Practice Address - Street 1:2418 24TH AVE S UNIT 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4183
Practice Address - Country:US
Practice Address - Phone:612-986-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1084176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty