Healthcare Provider Details

I. General information

NPI: 1811321979
Provider Name (Legal Business Name): MARYHELEN AYRES M.A., CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6594 E LAMPKINS RIDGE RD
BLOOMINGTON IN
47401-9155
US

IV. Provider business mailing address

6594 E LAMPKINS RIDGE RD
BLOOMINGTON IN
47401-9155
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-3564
  • Fax:
Mailing address:
  • Phone: 812-334-3564
  • 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: