Healthcare Provider Details

I. General information

NPI: 1720033384
Provider Name (Legal Business Name): CAROL MCCREADY 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

970 FOREST AVE
PORTLAND ME
04103-3331
US

IV. Provider business mailing address

81 RIVERMEADOW DR
STEEP FALLS ME
04085-6842
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-8881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number023218
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: