Provider Demographics
NPI:1811577083
Name:GRACE MIDWIFERY
Entity Type:Organization
Organization Name:GRACE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EDGELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:260-216-5690
Mailing Address - Street 1:524 W HOOSIER ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1019
Mailing Address - Country:US
Mailing Address - Phone:260-216-5690
Mailing Address - Fax:260-200-5472
Practice Address - Street 1:524 W HOOSIER ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1019
Practice Address - Country:US
Practice Address - Phone:260-216-5690
Practice Address - Fax:260-200-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing