MEDICARE: ELLEN CARTY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1164187670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN CARTY LLC

Provider Business Mailing Address
First Line	:	300 BUCK ISLAND RD APT 3I
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-2543
Country	:	US
Telephone Number	:	508-280-9539
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BUCK ISLAND RD APT 3I
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-2543
Country	:	US
Telephone Number	:	508-280-9539
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN CARTY
Credential	:	CNP
Telephone Number	:	508-280-9539

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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