Provider Demographics
NPI:1962461434
Name:CARR, MAUREEN P (RN CPNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:P
Last Name:CARR
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-535-1110
Mailing Address - Fax:978-535-2907
Practice Address - Street 1:10 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-535-1110
Practice Address - Fax:978-535-2907
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA115716364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2062852Medicaid
P07376Medicare UPIN