MEDICARE: ELIZABETH NAMALA BWOGI CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	230164	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0037724	OTHER	NEIGHBORHOOD HEALTH PLAN
2	93339	OTHER	HEALTHY START
3	93339	OTHER	CMSP

General Provider Information

NPI Number	:	1699721571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NAMALA BWOGI CNM

Provider Business Mailing Address
First Line	:	231 MAIN ST
Second Line	:	SUITE 302
City	:	BROCKTON
State	:	MA
Zip	:	02301-4342
Country	:	US
Telephone Number	:	508-559-1567
Fax Number	:	508-559-5073

Provider Business Practice Location Address
First Line	:	157 MAIN ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-4012
Country	:	US
Telephone Number	:	508-559-6699
Fax Number	:	508-583-4649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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