Provider Demographics
NPI:1841238409
Name:NP PRIMARY CARE, LLC
Entity type:Organization
Organization Name:NP PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE EMPLOYEE FAMILY NP
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:860-484-4376
Mailing Address - Street 1:9 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06778-2520
Mailing Address - Country:US
Mailing Address - Phone:860-484-4376
Mailing Address - Fax:
Practice Address - Street 1:9 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06778-2520
Practice Address - Country:US
Practice Address - Phone:860-484-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP95480Medicare UPIN