Provider Demographics
NPI:1255458246
Name:MCNALLY, CAROL JEAN (RN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-4222
Mailing Address - Fax:
Practice Address - Street 1:1010 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2600
Practice Address - Country:US
Practice Address - Phone:617-534-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265034163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool