Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 290-49 | WI |
N | 176B00000X | Midwife | 9000027 | KY |
NPI | 1023456340 |
---|---|
Provider Name | Michelle Patula |
First Address | Marion, IL 62959-2941 |
Second Address | Marion, IL 62959-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2013 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01 | N/A (01) |