Provider Demographics
NPI:1124576152
Name:CHAMOURES, MARA (NP-C)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:CHAMOURES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:BLUMETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 EAST ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3014
Mailing Address - Country:US
Mailing Address - Phone:668-389-2727
Mailing Address - Fax:
Practice Address - Street 1:40 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3014
Practice Address - Country:US
Practice Address - Phone:860-354-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002497363LF0000X
CT6738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily