Individual
LETITIA NICOLE QUAST-WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
938 MEZZANINE DR STE B, LAFAYETTE, IN 47905-8641
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041353072
IL
367A00000X
Advanced Practice Midwife
Primary
71004571A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000853874
ANTHEM PROVIDER NUMBER
IN
05
—
201205790
—
IN
Enumeration date
06/13/2013
Last updated
02/10/2021
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