Basic Information
| Provider Information | |||||||||
| NPI: | 1083614994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBRIEN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN MSN CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 NEW LUDLOW RD | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010204324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135333470 | ||||||||
| FaxNumber: | 4135336859 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 MAPLE STREET | ||||||||
| Address2: | SUITE 200 MIDWIFERY CARE OF HOLYOKE | ||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010406513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135354700 | ||||||||
| FaxNumber: | 4135354704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 188081 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 043202198 | 01 | CIGNA | OTHER | 043202198 | 01 | CBA | OTHER | 21220010314 | 01 | BEECH STREET | OTHER | CN0096 | 01 | BCBS OF MA | OTHER | 40476 | 01 | HEALTHY START | OTHER |