Individual
WILLIAM R. CARBONNEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 421-1400
(508) 421-1490
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
206199
MA
363L00000X
Nurse Practitioner
Primary
RN2061999
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110015777A
—
MA
Enumeration date
10/16/2006
Last updated
03/04/2021
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