Provider Demographics
NPI:1073880860
Name:MULCAHY, PEPPER MIRANDA (LPN)
Entity Type:Individual
Prefix:
First Name:PEPPER
Middle Name:MIRANDA
Last Name:MULCAHY
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 1:74 E MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1642
Mailing Address - Country:US
Mailing Address - Phone:607-377-4020
Mailing Address - Fax:
Practice Address - Street 1:74 E MORRIS ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1642
Practice Address - Country:US
Practice Address - Phone:607-377-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294940-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse