Healthcare Provider Details

I. General information

NPI: 1124267208
Provider Name (Legal Business Name): CARLA GAYLE CLEARY CNM MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 CENTER RUN DR
INDIANAPOLIS IN
46250-1945
US

IV. Provider business mailing address

8121 CENTER RUN DR
INDIANAPOLIS IN
46250-1945
US

V. Phone/Fax

Practice location:
  • Phone: 317-849-9304
  • Fax: 317-841-0523
Mailing address:
  • Phone: 317-849-9304
  • Fax: 317-841-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000077A&B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: