Provider Demographics
NPI:1154346831
Name:METCALF, MARCIA Y (APRN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:Y
Last Name:METCALF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-1014
Mailing Address - Country:US
Mailing Address - Phone:860-729-8628
Mailing Address - Fax:860-292-1671
Practice Address - Street 1:38 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088
Practice Address - Country:US
Practice Address - Phone:860-729-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001231363LP0808X
CT001231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004261228Medicaid
CT004261228Medicaid
MA004140505Medicaid
P00348Medicare UPIN
MA004140505Medicaid