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NPI Code Detail

MEDICARE: MRS. MYRA F CACACE GNP/ADM-BC, CDE

MEDICARE: MRS. MYRA F CACACE GNP/ADM-BC, CDE
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
1163WC0200XCritical Care Medicine Registered NurseNP144577MA
2363LG0600XGerontology Nurse PractitionerNP144577MA
3363LP2300XPrimary Care Nurse PractitionerNP144577MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2BCNP0559OTHERMABLUE CROSS BLUE SHIELD
349852OTHERMAFALLON

General Provider Information

NPI Number : 1518956010
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MYRA F CACACE GNP/ADM-BC, CDE
Provider Business Mailing Address
First Line : 5 NEPONSET ST FL STREET12
Second Line :
City : WORCESTER
State : MA
Zip : 01606-2714
Country : US
Telephone Number : 508-852-6175
Fax Number : 508-595-2123
Provider Business Practice Location Address
First Line : 5 NEPONSET ST
Second Line :
City : WORCESTER
State : MA
Zip : 01606-2714
Country : US
Telephone Number : 508-852-6175
Fax Number : 508-595-2123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 09/27/2018

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