Individual
MARY T ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
6920 INDIANAPOLIS BLVD, HAMMOND, IN 46324-2206
(219) 763-8112
(219) 764-3251
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
4704272662
MI
Other
Enumeration date
11/05/2009
Last updated
05/27/2014
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