Healthcare Provider Details

I. General information

NPI: 1265267785
Provider Name (Legal Business Name): MEKENZIE SPRINGER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 400
INDIANAPOLIS IN
46237-8633
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 400
INDIANAPOLIS IN
46237-8633
US

V. Phone/Fax

Practice location:
  • Phone: 260-273-8783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number28259659A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71016250A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000488A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: