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Individual
MARY BARACCO
Active
Individual
MARY BARACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
490245
CA
363L00000X
Nurse Practitioner
8853
CA
367A00000X
Advanced Practice Midwife
Primary
1211
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0081500
—
CA
01
—
GR0081501
MEDICAL
CA
Enumeration date
10/11/2006
Last updated
09/08/2016
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