Healthcare Provider Details

I. General information

NPI: 1265492425
Provider Name (Legal Business Name): CAROLYN A MCGILLIVRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 S COUNTY TRL SUITE 2B
EAST GREENWICH RI
02818-5082
US

IV. Provider business mailing address

1377 S COUNTY TRL SUITE 2B
EAST GREENWICH RI
02818-5082
US

V. Phone/Fax

Practice location:
  • Phone: 401-884-8900
  • Fax: 401-884-9199
Mailing address:
  • Phone: 401-884-8900
  • Fax: 401-884-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP 16726
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: