Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063696136 |
---|---|
Provider Name | Ms. Beth Anne Moonstone |
First Address | Amherst, MA 01002-1677 |
Second Address | Amherst, MA 01002-1677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 24/12/2007 |