Provider Demographics
NPI:1619975208
Name:BASTARACHE, LOUISE RACINE (CNM, NP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:RACINE
Last Name:BASTARACHE
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OBERY ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2237
Mailing Address - Country:US
Mailing Address - Phone:508-789-5716
Mailing Address - Fax:508-763-8196
Practice Address - Street 1:46 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2237
Practice Address - Country:US
Practice Address - Phone:508-830-6116
Practice Address - Fax:508-747-6308
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143429363L00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP1103OtherBCBS
13464OtherHARVARD PILGRIM
791798OtherTUFTS
CN0081OtherBCBS
MA0355747Medicaid
NP1103OtherBCBS
13464OtherHARVARD PILGRIM