Healthcare Provider Details

I. General information

NPI: 1962697284
Provider Name (Legal Business Name): MONROE COUNTY GOVERNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 S WALNUT ST
BLOOMINGTON IN
47401-3500
US

IV. Provider business mailing address

338 S WALNUT ST
BLOOMINGTON IN
47401-3500
US

V. Phone/Fax

Practice location:
  • Phone: 812-349-7343
  • Fax: 812-349-7346
Mailing address:
  • Phone: 812-349-7343
  • Fax: 812-349-7346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACKIE DONCEEL SQUIRES
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: CNM
Phone: 812-349-7344