Provider Demographics
NPI:1679730527
Name:MCDANIEL, ELIZABETH THIES (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:THIES
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2217
Mailing Address - Country:US
Mailing Address - Phone:812-334-3955
Mailing Address - Fax:812-334-5792
Practice Address - Street 1:1010 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2217
Practice Address - Country:US
Practice Address - Phone:812-334-3955
Practice Address - Fax:812-334-5792
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000061A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife