1356326946 NPI number — PAMELA J WARD CNM

Table of content: PAMELA J WARD CNM (NPI 1356326946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356326946 NPI number — PAMELA J WARD CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
PAMELA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356326946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 EAST AVE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
PAWTUCKET
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02860-5299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-727-4800
Provider Business Mailing Address Fax Number:
401-728-4437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-5299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-727-4800
Provider Business Practice Location Address Fax Number:
401-728-4437
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  CMW00128 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0367991 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MW00128 . This is a "LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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