Healthcare Provider Details

I. General information

NPI: 1023456340
Provider Name (Legal Business Name): MICHELLE PATULA CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N STATE ST
MARION IL
62959-2941
US

IV. Provider business mailing address

1014 N STATE ST
MARION IL
62959-2941
US

V. Phone/Fax

Practice location:
  • Phone: 618-694-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number9000027
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number290-49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: