Healthcare Provider Details

I. General information

NPI: 1609126804
Provider Name (Legal Business Name): ANGELA D LYTTLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL SUITE K
INDIANAPOLIS IN
46254
US

IV. Provider business mailing address

6620 PARKDALE PL, SUITE K
INDIANAPOLIS IN
46254
US

V. Phone/Fax

Practice location:
  • Phone: 317-437-3681
  • Fax: 855-279-1781
Mailing address:
  • Phone: 317-437-3681
  • Fax: 855-279-1781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: