| Doctor Name: | CHARITY MCCLURE |
| NPI Number: | 1366875007 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 005450 |
| Business Practice Address: | 45 Green Hollow Rd Danielson, CT - 062393509 |
| Business Phone Number: | 8607741255 |
| Business Fax Number: | 8609288283 |
| Mailing Address: | 320 Pomfret Street Csb 2, Attn: Credentialing Dpt PUTNAM |
| State: | CT |
| Postal Code: | 062601836 |
| Phone Number: | 8609286541 |
| Fax Number: | 8609636450 |
| NPI Enumeration Date: | 08/16/2013 |
| NPI Last Update Date: | 10/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 005450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |