Basic Information
Provider Information
NPI: 1578663639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRY
FirstName: PAULA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991000
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber: 4137941629
Practice Location
Address1: 759 CHESTNUT ST
Address2: WESSON GROUND
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137948336
FaxNumber: 4137945846
Other Information
ProviderEnumerationDate: 09/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X176244MAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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