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General NPI Number Information
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NPI Number | 1104007368
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Entity Type | Organization
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Legal Business Name | WAREHAM NURSE MIDWIVES PC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 332 MAIN STREET
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City | WAREHAM
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State | MA
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Zip | 02571
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Country | US
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Telephone | 508-295-3088
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Fax | 508-295-2079
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Provider Business Mailing Address
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Address Line | 332 MAIN STREET
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City | WAREHAM
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State | MA
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Zip | 02571
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Country | US
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Telephone | 508-295-3088
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Fax | 508-295-2079
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUISE RACINE BASTARACHE
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Credential | CNM MS NP
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Telephone | 508-295-3088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 143429
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 275550
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 143429
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License Number State | MA
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