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General NPI Number Information
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NPI Number | 1518956010
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Entity Type | Individual
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Provider Name | MYRA F CACACE GNP/ADM-BC, CDE
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 5 NEPONSET ST
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-852-6175
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Fax | 508-595-2123
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Provider Business Mailing Address
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Address Line | 5 NEPONSET ST FL STREET12
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-852-6175
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Fax | 508-595-2123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | NP144577
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP144577
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP144577
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License Number State | MA
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