Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1083009690 |
---|---|
Provider Name | Carly Pazakis |
First Address | Centerville, MA 02632-3225 |
Second Address | Centerville, MA 02632-3225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 31/03/2015 |