Provider Demographics
NPI:1265431209
Name:LODATO, MARY BETH (CERTIFIED NURSE MIDW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:LODATO
Suffix:
Gender:F
Credentials:CERTIFIED NURSE MIDW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3363
Mailing Address - Fax:812-450-3071
Practice Address - Street 1:316 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713
Practice Address - Country:US
Practice Address - Phone:812-436-4501
Practice Address - Fax:812-436-4510
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000026A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000328977OtherANTHEM BC/BS
IN200188920AMedicaid
11384964OtherCAQH PROVIDER ID
IN351791786109OtherCARESOURCE PROVIDER ID
IN200188920Medicaid
IN200188920AMedicaid
INM400035292Medicare Oscar/Certification