Healthcare Provider Details

I. General information

NPI: 1457466955
Provider Name (Legal Business Name): MEGAN DEIBEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD SUITE 250
KALAMAZOO MI
49048-1650
US

IV. Provider business mailing address

5943 STADIUM DR SUITE 3
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-5927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704152940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: