Healthcare Provider Details

I. General information

NPI: 1962830059
Provider Name (Legal Business Name): MARILYN CABRAL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
HOLYOKE MA
01040-6644
US

IV. Provider business mailing address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2826
  • Fax: 413-534-2829
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN2281842
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2281842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: