Provider Demographics
NPI:1265492425
Name:MCGILLIVRAY, CAROLYN A (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:MCGILLIVRAY
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 1:1377 S COUNTY TRL
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5082
Mailing Address - Country:US
Mailing Address - Phone:401-884-8900
Mailing Address - Fax:401-884-9199
Practice Address - Street 1:1377 S COUNTY TRL
Practice Address - Street 2:SUITE 2B
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5082
Practice Address - Country:US
Practice Address - Phone:401-884-8900
Practice Address - Fax:401-884-9199
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP 16726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINPP16726OtherNURSEPRACTITIONER LICENSE
RI0000027423OtherBLUE CROSS/BLUE SHIELD
RI408095OtherBLUE CHIP