Provider Demographics
NPI:1023045150
Name:BIRCH, ELIZABETH ROSS (MS, CNM)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ROSS
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MS, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2403
Mailing Address - Country:US
Mailing Address - Phone:812-336-0168
Mailing Address - Fax:812-335-7372
Practice Address - Street 1:421 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2403
Practice Address - Country:US
Practice Address - Phone:812-336-0168
Practice Address - Fax:812-335-7372
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000035367A00000X
IN28116356A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200227350AMedicaid
F48968Medicare UPIN
IN248430DMedicare Oscar/Certification