Provider Demographics
NPI:1659777563
Name:CVS CAREMARK MINUTECLINIC
Entity Type:Organization
Organization Name:CVS CAREMARK MINUTECLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-922-2435
Mailing Address - Street 1:52 KAYTONNE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1742
Mailing Address - Country:US
Mailing Address - Phone:860-922-2435
Mailing Address - Fax:
Practice Address - Street 1:1279 W MAIN ST
Practice Address - Street 2:ROBINWOOD SHOPPING PLAZA
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3101
Practice Address - Country:US
Practice Address - Phone:860-922-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty