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General NPI Number Information
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NPI Number | 1558886671
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Entity Type | Individual
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Provider Name | MACAELA CIRISH APRN
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Gender | Female
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 3801 EAST MAIN STREET SECOND FLOOR
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City | WATERBURY
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State | CT
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Zip | 06705
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Country | US
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Telephone | 203-709-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ARD CT
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City | MILFORD
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State | CT
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Zip | 06460-5903
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Country | US
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Telephone | 203-927-9828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7152
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License Number State | CT
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