MEDICARE: DONNA M DOYLE CNM, IBCLC

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	163W00000X	Registered Nurse	118961	MA
2	367A00000X	Advanced Practice Midwife	118961	MA

General Provider Information

NPI Number	:	1497869069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M DOYLE CNM, IBCLC

Provider Business Mailing Address
First Line	:	84 HIGHLAND AVE
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2727
Country	:	US
Telephone Number	:	978-741-7812
Fax Number	:	978-744-9594

Provider Business Practice Location Address
First Line	:	84 HIGHLAND AVE
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2727
Country	:	US
Telephone Number	:	978-745-3050
Fax Number	:	978-744-9594

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	04/01/2016

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