Provider Demographics
NPI:1609126804
Name:LYTTLE, ANGELA D (CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:LYTTLE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 PARKDALE PL, SUITE K
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254
Mailing Address - Country:US
Mailing Address - Phone:317-437-3681
Mailing Address - Fax:855-279-1781
Practice Address - Street 1:6620 PARKDALE PL
Practice Address - Street 2:SUITE K
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-437-3681
Practice Address - Fax:855-279-1781
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN09000221A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife