Provider Demographics
NPI:1487980694
Name:BESONG, CARMELLE S (NP)
Entity type:Individual
Prefix:MRS
First Name:CARMELLE
Middle Name:S
Last Name:BESONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56J SHREWSBURY GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3621
Mailing Address - Country:US
Mailing Address - Phone:774-276-0084
Mailing Address - Fax:508-798-4147
Practice Address - Street 1:56J SHREWSBURY GREEN DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3621
Practice Address - Country:US
Practice Address - Phone:781-330-1022
Practice Address - Fax:781-472-8747
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily