Provider Demographics
NPI:1184240046
Name:EMBRACE MIDWIFERY
Entity type:Organization
Organization Name:EMBRACE MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:508-734-3344
Mailing Address - Street 1:350 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:508-734-3344
Mailing Address - Fax:508-365-6140
Practice Address - Street 1:350 WALTON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:508-734-3344
Practice Address - Fax:508-365-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110120703AMedicaid