Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 234315 | MA |
NPI | 1083687487 |
---|---|
Provider Name | Mary Culliton |
First Address | Waltham, MA 02453-2721 |
Second Address | Waltham, MA 02453-2721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 13/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0378861 | (05) | MA |
P77283 | (02) | MA |