Healthcare Provider Details

I. General information

NPI: 1295593721
Provider Name (Legal Business Name): SAPPHIRA CHAMPANGE PRANGER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W SYCAMORE ST STE 260
KOKOMO IN
46901-6460
US

IV. Provider business mailing address

3219 CLIFTON AVE STE 210
CINCINNATI OH
45220-3041
US

V. Phone/Fax

Practice location:
  • Phone: 765-236-8457
  • Fax:
Mailing address:
  • Phone: 513-751-5900
  • Fax: 513-487-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000459A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019615
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number71016262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: