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General NPI Number Information
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NPI Number | 1619975208
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Entity Type | Individual
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Provider Name | LOUISE RACINE BASTARACHE CNM, NP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 46 OBERY ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-2237
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Country | US
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Telephone | 508-830-6116
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Fax | 508-747-6308
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Provider Business Mailing Address
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Address Line | 46 OBERY ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-2237
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Country | US
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Telephone | 508-789-5716
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Fax | 508-763-8196
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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 | 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 | 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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