Provider Demographics
NPI:1053892091
Name:LIFECYCLE WOMENS HEALTH
Entity type:Organization
Organization Name:LIFECYCLE WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:207-835-1720
Mailing Address - Street 1:246 WALNUT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1639
Mailing Address - Country:US
Mailing Address - Phone:617-244-3322
Mailing Address - Fax:617-244-1827
Practice Address - Street 1:169 SOUTH RD
Practice Address - Street 2:
Practice Address - City:READFIELD
Practice Address - State:ME
Practice Address - Zip Code:04355-3340
Practice Address - Country:US
Practice Address - Phone:207-835-1720
Practice Address - Fax:207-685-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNM152002367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty