MEDICARE: ERIN M. CASSIDENTE CPM, LM

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	176B00000X	Midwife	558-49	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	558-49	OTHER	WI	MIDWIFE LICENSE

General Provider Information

NPI Number	:	1679310171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN M. CASSIDENTE CPM, LM

Provider Business Mailing Address
First Line	:	W142N5030 GOLDEN FIELDS DR
Second Line	:
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-6988
Country	:	US
Telephone Number	:	414-795-6302
Fax Number	:	844-972-1548

Provider Business Practice Location Address
First Line	:	800 E CLARKE ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3007
Country	:	US
Telephone Number	:	414-795-6302
Fax Number	:	844-972-1548

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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