Provider Demographics
NPI:1417116492
Name:CHRISTIE-MCAULIFFE, CAROLYN A (PHD, FNP)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:A
Last Name:CHRISTIE-MCAULIFFE
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-707-7686
Mailing Address - Fax:315-221-9506
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 124
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-707-7686
Practice Address - Fax:315-221-9506
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY335494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03012764Medicaid