MEDICARE: MOLLY CHRISTINE BURKE C.P.M., L.M.

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	175M00000X	Lay Midwife	107.0128864	VT

General Provider Information

NPI Number	:	1871034496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY CHRISTINE BURKE C.P.M., L.M.

Provider Business Mailing Address
First Line	:	18 MARBLE AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4731
Country	:	US
Telephone Number	:	802-355-6775
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 MARBLE AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4731
Country	:	US
Telephone Number	:	802-355-6775
Fax Number	:

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

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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