MEDICARE: MICHELLE M MATTICE DANCER MS, CNM, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN 270174	OH
2	163W00000X	Registered Nurse	28136314A	IN
3	176B00000X	Midwife	09000105A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215062617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M MATTICE DANCER MS, CNM, RN

Provider Business Mailing Address
First Line	:	11785 MORRISON MIKESELL RD
Second Line	:
City	:	NEW PARIS
State	:	OH
Zip	:	45347-9214
Country	:	US
Telephone Number	:	937-437-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	11785 MORRISON MIKESELL RD
Second Line	:
City	:	NEW PARIS
State	:	OH
Zip	:	45347-9214
Country	:	US
Telephone Number	:	937-437-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	09/11/2025

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