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NPI Code Detail

MEDICARE: SACRED ROOTS MIDWIFERY, LLC

MEDICARE: SACRED ROOTS MIDWIFERY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice Midwife09000221AIN

General Provider Information

NPI Number : 1215390778
Entity Type Code : Organization
Provider Name (Legal Business Name) : SACRED ROOTS MIDWIFERY, LLC
Provider Business Mailing Address
First Line : 6620 PARKDALE PL
Second Line : SUITE K
City : INDIANAPOLIS
State : IN
Zip : 46254-5620
Country : US
Telephone Number : 317-437-3681
Fax Number : 317-552-2671
Provider Business Practice Location Address
First Line : 6620 PARKDALE PL
Second Line : SUITE K
City : INDIANAPOLIS
State : IN
Zip : 46254-5620
Country : US
Telephone Number : 317-437-3681
Fax Number : 317-552-2671
Authorized Official
Title or Position : CO-OWNER/MIDWIFERY DIRECTOR
Name : ANGELA LYTTLE
Credential : CNM
Telephone Number : 317-437-3681
Provider Enumeration Date : 04/01/2016
Last Update Date : 05/11/2017

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Directions to “SACRED ROOTS MIDWIFERY, LLC ” Practice Location

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