Individual
MRS. JACKIE DONCEEL SQUIRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
338 S WALNUT ST, BLOOMINGTON, IN 47401-3500
(812) 349-7343
(812) 349-7346
Mailing address
9501 W WOLF MOUNTAIN RD, GOSPORT, IN 47433-9597
(812) 876-4151
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
72000030
IN
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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