Healthcare Provider Details

I. General information

NPI: 1487809877
Provider Name (Legal Business Name): KATHRYN ELIZABETH MOWERY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 OFFICE PARK DR
MARION IL
62959-6477
US

IV. Provider business mailing address

3408 OFFICE PARK DR
MARION IL
62959-6477
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5266
  • Fax: 618-997-5285
Mailing address:
  • Phone: 618-997-5266
  • Fax: 618-997-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209007355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: