Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1073830816 |
---|---|
Provider Name | Cassandra Etienne |
First Address | Brockton, MA 02301-4042 |
Second Address | Brockton, MA 02301-4042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 30/12/2011 |