Provider Demographics
NPI:1295196038
Name:MCNULTY, CARLA (NP)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:
Last Name:MCNULTY
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 1:257 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1530
Mailing Address - Country:US
Mailing Address - Phone:914-806-8055
Mailing Address - Fax:
Practice Address - Street 1:257 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1530
Practice Address - Country:US
Practice Address - Phone:914-806-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily