Provider Demographics
NPI:1033260484
Name:MCFADDEN, BILLIE IRENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:IRENE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4726
Mailing Address - Country:US
Mailing Address - Phone:845-383-3676
Mailing Address - Fax:
Practice Address - Street 1:42 NORTH DR
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4726
Practice Address - Country:US
Practice Address - Phone:845-383-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089433-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY089433-1OtherLPN LICENES NUMBER
NY02683434Medicaid