Provider Demographics
NPI:1003239831
Name:MCCORMICK, KAUNIKO (RN)
Entity Type:Individual
Prefix:
First Name:KAUNIKO
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BAYCHESTER AVE
Mailing Address - Street 2:H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1704
Mailing Address - Country:US
Mailing Address - Phone:718-450-0826
Mailing Address - Fax:
Practice Address - Street 1:900 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1704
Practice Address - Country:US
Practice Address - Phone:718-450-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2021-05-06
Deactivation Date:2021-02-02
Deactivation Code:
Reactivation Date:2021-04-07
Provider Licenses
StateLicense IDTaxonomies
NY677831163W00000X
NY347039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse