Provider Demographics
NPI:1487289641
Name:CORCORAN, CAROL P (RN, CNS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:P
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1847
Mailing Address - Country:US
Mailing Address - Phone:781-953-8149
Mailing Address - Fax:
Practice Address - Street 1:34 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1847
Practice Address - Country:US
Practice Address - Phone:781-953-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN164580364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist