Provider Demographics
NPI:1659459634
Name:TRABULSI, MARY I (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TRABULSI
Suffix:I
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:FOUNDERS 454
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-2229
Mailing Address - Fax:617-724-3498
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FOUNDERS 454
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-2229
Practice Address - Fax:617-724-3498
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA204215367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATRCN0279OtherBLUE CROSS BLUE SHIELD
MA59151OtherFALLON
MA59151OtherFALLON