Provider Demographics
NPI:1184791410
Name:MACRI, CHARLENE J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:J
Last Name:MACRI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:CLAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13322-0275
Mailing Address - Country:US
Mailing Address - Phone:315-839-5575
Mailing Address - Fax:315-839-5587
Practice Address - Street 1:417 HENRY STREET
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-0710
Practice Address - Country:US
Practice Address - Phone:315-866-0210
Practice Address - Fax:315-866-5883
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332678363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951124Medicaid