Healthcare Provider Details

I. General information

NPI: 1053781732
Provider Name (Legal Business Name): STEPHANIE SANDWICH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 OLD ROAD TO 9 ACRE COR SUITE 830
CONCORD MA
01742-4181
US

IV. Provider business mailing address

131 OLD ROAD TO 9 ACRE COR STE 830
CONCORD MA
01742-4191
US

V. Phone/Fax

Practice location:
  • Phone: 978-371-1396
  • Fax:
Mailing address:
  • Phone: 978-371-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2309345
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN2309345
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN2309345
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number201406612RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: