Provider Demographics
NPI:1184311425
Name:MORMAN, CILICIA WILOLA (RN, CHHP)
Entity type:Individual
Prefix:
First Name:CILICIA
Middle Name:WILOLA
Last Name:MORMAN
Suffix:
Gender:F
Credentials:RN, CHHP
Other - Prefix:PROF
Other - First Name:CILICIA
Other - Middle Name:WILOLA
Other - Last Name:MORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4231 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1929
Mailing Address - Country:US
Mailing Address - Phone:317-615-9711
Mailing Address - Fax:
Practice Address - Street 1:4231 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1929
Practice Address - Country:US
Practice Address - Phone:317-615-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 374J00000X
IN28222619A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No175F00000XOther Service ProvidersNaturopath
No374J00000XNursing Service Related ProvidersDoula