Provider Demographics
NPI:1396865747
Name:MCCAVANAGH, DEBRA JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JO
Last Name:MCCAVANAGH
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 1:337 UNQUA RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5319
Mailing Address - Country:US
Mailing Address - Phone:516-798-2551
Mailing Address - Fax:
Practice Address - Street 1:337 UNQUA RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5319
Practice Address - Country:US
Practice Address - Phone:516-798-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336822163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health