Healthcare Provider Details

I. General information

NPI: 1164416012
Provider Name (Legal Business Name): AMY LS MEFFORD CNM MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 N SEMINARY ST STE 402
GALESBURG IL
61401-2852
US

IV. Provider business mailing address

834 N SEMINARY ST STE 402
GALESBURG IL
61401-2852
US

V. Phone/Fax

Practice location:
  • Phone: 309-343-5117
  • Fax: 309-343-0029
Mailing address:
  • Phone: 309-343-5117
  • Fax: 309-343-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: