Healthcare Provider Details

I. General information

NPI: 1447197801
Provider Name (Legal Business Name): ILENE D PEREZ CNM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PLAIN ST
BRAINTREE MA
02184-7077
US

IV. Provider business mailing address

125 PLAIN ST
BRAINTREE MA
02184-7077
US

V. Phone/Fax

Practice location:
  • Phone: 857-251-0750
  • Fax:
Mailing address:
  • Phone: 857-251-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN2314385
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: