Healthcare Provider Details

I. General information

NPI: 1447963079
Provider Name (Legal Business Name): BIANCA MARIA COTHEN CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SPAULDING LN
HOLLIS NH
03049-6512
US

IV. Provider business mailing address

16 SPAULDING LN
HOLLIS NH
03049-6512
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-0323
  • Fax:
Mailing address:
  • Phone: 617-417-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number1078
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: