Healthcare Provider Details

I. General information

NPI: 1013626902
Provider Name (Legal Business Name): LAUREN HALE CPM, CDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 E NORTH COUNTY LINE RD
HUNTERTOWN IN
46748-9287
US

IV. Provider business mailing address

2932 E WAITS RD
KENDALLVILLE IN
46755-3370
US

V. Phone/Fax

Practice location:
  • Phone: 260-450-4034
  • Fax:
Mailing address:
  • Phone: 260-438-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number90000018A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: