Provider Demographics
NPI:1851350359
Name:CARBONNEAU, M. FRANCINE (NP)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:FRANCINE
Last Name:CARBONNEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:M
Other - Middle Name:FRANCINE
Other - Last Name:KEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC - REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:257 STATION AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664
Practice Address - Country:US
Practice Address - Phone:508-394-8303
Practice Address - Fax:508-398-6680
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1059OtherBCBS
MANP1059OtherBCBS
S53992Medicare UPIN