Healthcare Provider Details

I. General information

NPI: 1902926041
Provider Name (Legal Business Name): CAROLYN MCDONALD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58887 BREMEN HWY
MISHAWAKA IN
46544-6414
US

IV. Provider business mailing address

58887 BREMEN HWY
MISHAWAKA IN
46544-6414
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-6182
  • Fax: 574-255-6376
Mailing address:
  • Phone: 574-255-6182
  • Fax: 574-255-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28130755A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704207956
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000046A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704207956
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: