Healthcare Provider Details

I. General information

NPI: 1063464337
Provider Name (Legal Business Name): CAROLYN T MCCARTHY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W BRUCE ST SUITE 200
MILWAUKEE WI
53204-1667
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-1400
  • Fax:
Mailing address:
  • Phone: 3-262-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704216109
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13525-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: