Basic Information
| Provider Information | |||||||||
| NPI: | 1295889681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLYMOUTH | ||||||||
| FirstName: | CARINE | ||||||||
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| Credential: | NP, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 74 HOWLAND ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023022855 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 YORK ST | ||||||||
| Address2: | |||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020721829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813440600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN201984 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | RN201984 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 110099918A | 05 | MA | MEDICAID | 110099918B | 05 | MA | MEDICAID |