MEDICARE: MRS. ILONKA WILHELMINE HERBER RN, CNM

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	367A00000X	Advanced Practice Midwife	09000016A	IN

General Provider Information

NPI Number	:	1326129107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILONKA WILHELMINE HERBER RN, CNM

Provider Business Mailing Address
First Line	:	6703 N EWING ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3750
Country	:	US
Telephone Number	:	317-259-1816
Fax Number	:	317-259-1816

Provider Business Practice Location Address
First Line	:	200 S MERIDIAN ST
Second Line	:	SUITE 400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1055
Country	:	US
Telephone Number	:	317-637-4343
Fax Number	:	317-637-4344

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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