# MARY BARACCO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1255429528
- **Gender:** F
- **Credential:** CNM NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 490245 | CA | — |
| 363L00000X | Nurse Practitioner | 8853 | CA | — |
| 367A00000X | Advanced Practice Midwife | 1211 | CA | Yes |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 09/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0081500 | — | CA |
| 01 | — | GR0081501 | MEDICAL | CA |