Individual
CARLY MELISSA MADORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
248 FLANDERS RD, NIANTIC, CT 06357-1264
(860) 739-5426
Mailing address
32 PLAINS RD, HADDAM, CT 06438-1259
(860) 714-7420
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
004830
CT
363LP0200X
Pediatric Nurse Practitioner
4830
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396012498
—
CT
01
—
D400170759
MEDICARE- NGS
CT
Enumeration date
11/18/2011
Last updated
09/25/2015
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