Healthcare Provider Details

I. General information

NPI: 1407801921
Provider Name (Legal Business Name): CAROLE J. MCWILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS ROAD
BEDFORD MA
01730-1198
US

IV. Provider business mailing address

3 RAINBOW AVE
CHELMSFORD MA
01824-1631
US

V. Phone/Fax

Practice location:
  • Phone: 617-687-2172
  • Fax:
Mailing address:
  • Phone: 978-250-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number128912
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: