Provider Demographics
NPI:1306995675
Name:SCHWARTZ MUMFORD, MARY (CNM, APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SCHWARTZ MUMFORD
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 BETTY POND RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1123
Mailing Address - Country:US
Mailing Address - Phone:401-965-6897
Mailing Address - Fax:401-647-4814
Practice Address - Street 1:168 BETTY POND RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:RI
Practice Address - Zip Code:02831-1123
Practice Address - Country:US
Practice Address - Phone:401-965-6897
Practice Address - Fax:401-965-6897
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMW00103176B00000X
RINP36953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021605Medicaid
RI411803OtherUGS
RI411833OtherUGS
RI411813OtherUGS