Healthcare Provider Details

I. General information

NPI: 1265431209
Provider Name (Legal Business Name): MARY BETH LODATO CERTIFIED NURSE MIDW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CHANDLER AVE
EVANSVILLE IN
47713
US

IV. Provider business mailing address

PO BOX 3407
EVANSVILLE IN
47733-3407
US

V. Phone/Fax

Practice location:
  • Phone: 812-436-4501
  • Fax: 812-436-4510
Mailing address:
  • Phone: 812-450-3363
  • Fax: 812-450-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000026A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: