Provider Demographics
NPI:1417259045
Name:LOUDENBER, ELIZABETH A (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LOUDENBER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 EASTPORT CENTRE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2910
Mailing Address - Country:US
Mailing Address - Phone:219-464-0409
Mailing Address - Fax:219-464-2376
Practice Address - Street 1:880 EASTPORT CENTRE DR STE 200
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2910
Practice Address - Country:US
Practice Address - Phone:219-464-0409
Practice Address - Fax:219-464-2376
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000050A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife