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NPI Code Detail

MEDICARE: MS. LARA CORINNE HOLBROOK CNM

MEDICARE: MS. LARA CORINNE HOLBROOK 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
1367A00000XAdvanced Practice MidwifeRN1005847DC
2367A00000XAdvanced Practice MidwifeRN00141978WA
3367A00000XAdvanced Practice Midwife257882MA

General Provider Information

NPI Number : 1922181759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LARA CORINNE HOLBROOK CNM
Provider Business Mailing Address
First Line : 10 CAMELIA AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-1008
Country : US
Telephone Number : 617-665-2229
Fax Number :
Provider Business Practice Location Address
First Line : 10 CAMELIA AVE
Second Line :
City : CAMBRIDGE
State : MA
Zip : 02139-1008
Country : US
Telephone Number : 617-665-2229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 04/03/2008

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