MEDICARE: RONAE CLELAND CLS

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	374J00000X	Doula		IN

General Provider Information

NPI Number	:	1285366054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONAE CLELAND CLS

Provider Business Mailing Address
First Line	:	602 E PLEASANT CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-9778
Country	:	US
Telephone Number	:	906-366-0347
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E RUDISILL BLVD STE 102B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1756
Country	:	US
Telephone Number	:	906-366-0347
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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Directions to “ RONAE CLELAND CLS” Practice Location

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