Provider Demographics
NPI:1336427236
Name:NIRO, CARLA-MARIE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CARLA-MARIE
Middle Name:
Last Name:NIRO
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2537
Mailing Address - Country:US
Mailing Address - Phone:508-993-8332
Mailing Address - Fax:774-264-9577
Practice Address - Street 1:25 OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2537
Practice Address - Country:US
Practice Address - Phone:508-993-8332
Practice Address - Fax:774-264-9577
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN/NP2282041363LP0808X
RINPP37628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002410104Medicare PIN
RI1336427236Medicare UPIN