Healthcare Provider Details

I. General information

NPI: 1154346831
Provider Name (Legal Business Name): MARCIA Y METCALF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BRIDGE ST
EAST WINDSOR CT
06088
US

IV. Provider business mailing address

PO BOX 1014
EAST WINDSOR CT
06088-1014
US

V. Phone/Fax

Practice location:
  • Phone: 860-729-8628
  • Fax:
Mailing address:
  • Phone: 860-729-8628
  • Fax: 860-292-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCT001231
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: