Healthcare Provider Details

I. General information

NPI: 1376623983
Provider Name (Legal Business Name): REBECCA A FAY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

IV. Provider business mailing address

145 MILK STREET
BOSTON MA
02109
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0940
  • Fax: 617-770-0526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number163395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: