=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770926628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTICUT VALLEY MIDWIFERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 10/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 W SWANZEY RD
-----------------------------------------------------
City | SWANZEY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03446-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-352-5860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 W SWANZEY RD
-----------------------------------------------------
City | SWANZEY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03446-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-352-5860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARY LAWLOR
-----------------------------------------------------
Credential | CPM
-----------------------------------------------------
Telephone | 603-352-5860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 107-0000007
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------