Healthcare Provider Details

I. General information

NPI: 1508621624
Provider Name (Legal Business Name): TIFFANY MARIE DOWNING CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NORTHPARK DR
COLUMBUS IN
47203-2216
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5383
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-3311
  • Fax:
Mailing address:
  • Phone: 812-376-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number71015037A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: