Provider Demographics
NPI:1164576930
Name:CORREIA, PHYLLIS (CNM)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:CORREIA
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 1:1151 ROBESON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5566
Mailing Address - Country:US
Mailing Address - Phone:508-730-1666
Mailing Address - Fax:508-646-7119
Practice Address - Street 1:1151 ROBESON ST STE 201
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5566
Practice Address - Country:US
Practice Address - Phone:508-730-1666
Practice Address - Fax:508-646-7119
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138498367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0708887Medicaid
MAP21958Medicare UPIN
MANP2953Medicare ID - Type UnspecifiedMEDICARE