MEDICARE: CVS CAREMARK MINUTECLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1659777563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CVS CAREMARK MINUTECLINIC

Provider Business Mailing Address
First Line	:	52 KAYTONNE AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06710-1742
Country	:	US
Telephone Number	:	860-922-2435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1279 W MAIN ST
Second Line	:	ROBINWOOD SHOPPING PLAZA
City	:	WATERBURY
State	:	CT
Zip	:	06708-3101
Country	:	US
Telephone Number	:	860-922-2435
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MS. CARMEN IVETTE MARTELL
Credential	:	APRN
Telephone Number	:	860-922-2435

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/14/2014

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