Healthcare Provider Details

I. General information

NPI: 1326129107
Provider Name (Legal Business Name): ILONKA WILHELMINE HERBER RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MERIDIAN ST SUITE 400
INDIANAPOLIS IN
46225-1055
US

IV. Provider business mailing address

6703 N EWING ST
INDIANAPOLIS IN
46220-3750
US

V. Phone/Fax

Practice location:
  • Phone: 317-637-4343
  • Fax: 317-637-4344
Mailing address:
  • Phone: 317-259-1816
  • Fax: 317-259-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000016A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: