Healthcare Provider Details

I. General information

NPI: 1437441367
Provider Name (Legal Business Name): MICHIANA NURSE-MIDWIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E MADISON ST SUITE B
GOSHEN IN
46526-3938
US

IV. Provider business mailing address

113 E MADISON ST SUITE B
GOSHEN IN
46526-3938
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-8771
  • Fax: 574-534-8774
Mailing address:
  • Phone: 574-534-8771
  • Fax: 574-534-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number72000064A
License Number StateIN

VIII. Authorized Official

Name: LAURA MARIE GILBERT
Title or Position: OWNER
Credential: CNM
Phone: 574-534-8771