Provider Demographics
NPI:1164401493
Name:MCCARTHY, CHRISTINE NILSON (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NILSON
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1516
Mailing Address - Country:US
Mailing Address - Phone:860-836-3740
Mailing Address - Fax:
Practice Address - Street 1:185 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2107
Practice Address - Country:US
Practice Address - Phone:860-465-5263
Practice Address - Fax:860-465-4560
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002216363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S60703Medicare UPIN