Provider Demographics
NPI:1366836801
Name:MCCRAY OMEALLY, PAULA GEORGIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:GEORGIA
Last Name:MCCRAY OMEALLY
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 1:668 E 236TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1703
Mailing Address - Country:US
Mailing Address - Phone:347-427-1889
Mailing Address - Fax:
Practice Address - Street 1:668 E 236TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1703
Practice Address - Country:US
Practice Address - Phone:347-427-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse