Healthcare Provider Details

I. General information

NPI: 1013562776
Provider Name (Legal Business Name): CATHARINE SCULLY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 IMPERIAL PL UNIT 2D
PROVIDENCE RI
02903-4642
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-727-4800
  • Fax: 401-921-6923
Mailing address:
  • Phone: 401-273-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM00201
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: