Individual
JENNIFER J AVERILL MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
257370
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1300709
—
MA
01
—
CN0334
BLUE SHIELD NUMBER
MA
01
—
Y10141
MEDICARE GROUP #
—
Enumeration date
04/21/2006
Last updated
09/02/2010
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