Provider Demographics
NPI:1376517631
Name:MCCORMICK, MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCCORMICK
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 1:1305 POST RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-292-2000
Mailing Address - Fax:203-255-5212
Practice Address - Street 1:1305 POST RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-292-2000
Practice Address - Fax:203-255-5212
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500000467Medicare ID - Type Unspecified
CTP11687Medicare UPIN