Healthcare Provider Details

I. General information

NPI: 1932556552
Provider Name (Legal Business Name): MIDWIVES CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MCKINLEY AVE
SOUTH BEND IN
46615-2739
US

IV. Provider business mailing address

2930 MCKINLEY AVE
SOUTH BEND IN
46615-2739
US

V. Phone/Fax

Practice location:
  • Phone: 574-400-2558
  • Fax: 574-400-2557
Mailing address:
  • Phone: 574-400-2558
  • Fax: 574-400-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000084A
License Number StateIN

VIII. Authorized Official

Name: KRISTIN LYNN VINCENT
Title or Position: OWNER
Credential: CNM
Phone: 574-400-2558