# EARTHEN VESSELS NURSE MIDWIFERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053657775
- **Authorized official:** MRS. JANIS L CHRISSIKOS CNM (CERTIFIED NURSE MIDWIFE)
- **Authorized official phone:** (260) 704-7166

## Contact information

- **Practice address:** 251 AIRPORT NORTH OFFICE PARK, FORT WAYNE, IN 46825-6702
- **Practice address phone:** (260) 704-7166
- **Practice address fax:** (260) 357-0282
- **Mailing address:** 1755 COUNTY ROAD 36, AUBURN, IN 46706-9404
- **Mailing address phone:** (260) 704-7166
- **Mailing address fax:** (260) 357-0282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 09000220A | IN | Yes |

## Other

- **Enumeration date:** 12/27/2012
- **Last updated:** 12/27/2012