Provider Demographics
NPI:1306031935
Name:MACLELLAN, CAROLE P (APRN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:P
Last Name:MACLELLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 KONDRACKI LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4951
Mailing Address - Country:US
Mailing Address - Phone:203-265-6771
Mailing Address - Fax:
Practice Address - Street 1:1 E BRIDLEWOOD TRL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9339
Practice Address - Country:US
Practice Address - Phone:860-202-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400003877Medicare PIN
500002092Medicare PIN