Provider Demographics
NPI:1407074941
Name:MCCORMICK, ROSEMARY BRIDGET (BSN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:BRIDGET
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 DOUGLAS CRES
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5907
Mailing Address - Country:US
Mailing Address - Phone:315-797-3915
Mailing Address - Fax:
Practice Address - Street 1:2222 DOUGLAS CRES
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5907
Practice Address - Country:US
Practice Address - Phone:315-797-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY428345163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02831170Medicaid