Provider Demographics
NPI:1245612613
Name:MCCARTNEY, JOAN PAULINE (LPN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:PAULINE
Last Name:MCCARTNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:PAULINE
Other - Last Name:DICORSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:B10019 (118) DURHAM VA MEDICAL CENTER
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-6858
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:B10019 (118) DURHAM VA MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81966261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center