MEDICARE: MS. KATHLEEN MARIE TIRRELL CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	MW00063	RI

General Provider Information

NPI Number	:	1154537728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MARIE TIRRELL CNM

Provider Business Mailing Address
First Line	:	358 BROADWAY
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-1735
Country	:	US
Telephone Number	:	401-846-5590
Fax Number	:

Provider Business Practice Location Address
First Line	:	358 BROADWAY
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-1735
Country	:	US
Telephone Number	:	401-846-5590
Fax Number	:	401-848-7573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	02/05/2011

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