Healthcare Provider Details

I. General information

NPI: 1538596572
Provider Name (Legal Business Name): JENNIFER LOUISA WILLIAMS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13694 E SHADY MEADOWS DR
BLOOMINGTON IN
47403-6203
US

IV. Provider business mailing address

13694 E SHADY MEADOWS DR
BLOOMINGTON IN
47403-6203
US

V. Phone/Fax

Practice location:
  • Phone: 812-369-0916
  • Fax:
Mailing address:
  • Phone: 812-369-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: