Healthcare Provider Details

I. General information

NPI: 1932967403
Provider Name (Legal Business Name): CHUANTIAVA WILLIAMS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 N MERIDIAN ST STE 420
CARMEL IN
46032-1581
US

IV. Provider business mailing address

1630 WEDGEWOOD PL
AVON IN
46123-5535
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8500
  • Fax:
Mailing address:
  • Phone: 219-487-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000450A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: