Basic Information
| Provider Information | |||||||||
| NPI: | 1265431209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LODATO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | CERTIFIED NURSE MIDW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3407 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477333407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124503363 | ||||||||
| FaxNumber: | 8124503071 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 CHANDLER AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124364501 | ||||||||
| FaxNumber: | 8124364510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 72000026A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 000000328977 | 01 | ANTHEM BC/BS | OTHER | 200188920A | 05 | IN | MEDICAID | 11384964 | 01 | CAQH PROVIDER ID | OTHER | 351791786109 | 01 | IN | CARESOURCE PROVIDER ID | OTHER | 200188920 | 05 | IN | MEDICAID |