Provider Demographics
NPI:1013562776
Name:SCULLY, CATHARINE (CNM)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:
Last Name:SCULLY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:
Practice Address - Street 1:18 IMPERIAL PL UNIT 2D
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4642
Practice Address - Country:US
Practice Address - Phone:401-727-4800
Practice Address - Fax:401-921-6923
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA176B00000X
RICNM00201176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife