Individual
MERCEDES DEL CARMEN MORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
621 MEMORIAL DR, STE 403, SOUTH BEND, IN 46601-1063
(574) 647-1405
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
4704237039
MI
363L00000X
Nurse Practitioner
71004286A
IN
367A00000X
Advanced Practice Midwife
4704237039
MI
367A00000X
Advanced Practice Midwife
Primary
71004286A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000080642
BCBS BMG SOUTHEAST NEIGHBORHOOD CTR
IN
01
—
000000814990
BCBS BMG CENTRAL NEIGHBORHOOD HEALTH CTR
IN
01
—
000000815003
BCBS BMG CENTENNIAL NEIGHBORHOOD HEALTH CTR
IN
05
—
200530760
—
IN
01
—
236040264
MEDICARE PTAN
IN
Enumeration date
03/03/2006
Last updated
01/05/2018
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