Provider Demographics
NPI:1740262567
Name:MCNATT, MERRILYN (APRN)
Entity type:Individual
Prefix:
First Name:MERRILYN
Middle Name:
Last Name:MCNATT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4706
Mailing Address - Country:US
Mailing Address - Phone:860-442-9646
Mailing Address - Fax:860-439-0747
Practice Address - Street 1:342 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4706
Practice Address - Country:US
Practice Address - Phone:860-442-9646
Practice Address - Fax:860-439-0747
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001821363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004216356Medicaid
CT004216356Medicaid