Provider Demographics
NPI:1912678970
Name:FERNANDES, CAROLYN MCPHERSON (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MCPHERSON
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 WILSON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5012
Mailing Address - Country:US
Mailing Address - Phone:603-665-7450
Mailing Address - Fax:603-665-7450
Practice Address - Street 1:293 WILSON ST STE 102
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5012
Practice Address - Country:US
Practice Address - Phone:603-665-7450
Practice Address - Fax:603-665-7450
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015098363LF0000X
NH086621-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily