Healthcare Provider Details

I. General information

NPI: 1255506879
Provider Name (Legal Business Name): PAIGE E MCDANIEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SHELBY ST
INDIANAPOLIS IN
46203-1151
US

IV. Provider business mailing address

3401 E RAYMOND ST
INDIANAPOLIS IN
46203-4744
US

V. Phone/Fax

Practice location:
  • Phone: 317-488-2040
  • Fax: 317-488-2051
Mailing address:
  • Phone: 317-788-9769
  • Fax: 317-781-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704264606
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: