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NPI Code Detail

MEDICARE: MOONSTONE MIDWIFERY & FAMILY HEALTH

MEDICARE: MOONSTONE MIDWIFERY & FAMILY HEALTH
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
1367A00000XAdvanced Practice Midwife09000144AIN

General Provider Information

NPI Number : 1841528312
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOONSTONE MIDWIFERY & FAMILY HEALTH
Provider Business Mailing Address
First Line : 3201 INWOOD DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-5909
Country : US
Telephone Number : 260-482-1369
Fax Number : 260-482-1369
Provider Business Practice Location Address
First Line : 3201 INWOOD DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46815-5909
Country : US
Telephone Number : 260-482-1369
Fax Number : 260-482-1369
Authorized Official
Title or Position : OWNER
Name : GRETCHEN H JENKINS
Credential : C.N.M.
Telephone Number : 260-482-1369
Provider Enumeration Date : 11/22/2009
Last Update Date : 11/22/2009

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Directions to “MOONSTONE MIDWIFERY & FAMILY HEALTH ” Practice Location

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