Individual
CHARITY MCCLURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
45 GREEN HOLLOW RD, DANIELSON, CT 06239-3509
(860) 774-1255
(860) 928-8283
Mailing address
320 POMFRET STREET CSB 2, ATTN: CREDENTIALING DPT, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6450
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
005450
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
08/16/2013
Last updated
10/08/2015
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