MEDICARE: CAROL MARJORIE CLARKE-MONTAQUE

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	163WS0200X	School Registered Nurse	R43870	CT

General Provider Information

NPI Number	:	1376161349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MARJORIE CLARKE-MONTAQUE

Provider Business Mailing Address
First Line	:	3 GREEN MANOR DR
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-3519
Country	:	US
Telephone Number	:	860-869-4055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 GREEN MANOR DR
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06118-3519
Country	:	US
Telephone Number	:	860-869-4055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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Directions to “ CAROL MARJORIE CLARKE-MONTAQUE ” Practice Location

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