MEDICARE: MRS. ANNETTE ELIZABETH EDGELL 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	163W00000X	Registered Nurse	28160284A	IN
2	367A00000X	Advanced Practice Midwife	09000329A	IN

General Provider Information

NPI Number	:	1750933412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE ELIZABETH EDGELL CNM

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8028 CARNEGIE BLVD STE 300
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5788
Country	:	US
Telephone Number	:	260-425-6650
Fax Number	:	260-755-6233

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	04/04/2025

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