Basic Information
| Provider Information | |||||||||
| NPI: | 1053892091 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFECYCLE WOMENS HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
| FaxNumber: | 6172441827 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 SOUTH RD | ||||||||
| Address2: | |||||||||
| City: | READFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043553340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078351720 | ||||||||
| FaxNumber: | 2076853035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | KAMIN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CNM | ||||||||
| AuthorizedOfficialTelephone: | 2078351720 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CNM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | CNM152002 | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.