Healthcare Provider Details

I. General information

NPI: 1144259201
Provider Name (Legal Business Name): CATHERINE E MCDONOUGH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N SAINT JOSEPH AVE
NILES MI
49120-2296
US

IV. Provider business mailing address

60 N SAINT JOSEPH AVE
NILES MI
49120-2296
US

V. Phone/Fax

Practice location:
  • Phone: 269-687-0808
  • Fax: 269-687-0811
Mailing address:
  • Phone: 269-687-0808
  • Fax: 269-687-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704215752
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: