Provider Demographics
NPI:1407552821
Name:MYERS, MACEY NICOLE (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:MACEY
Middle Name:NICOLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SPRAGUE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-9750
Mailing Address - Country:US
Mailing Address - Phone:716-708-5660
Mailing Address - Fax:
Practice Address - Street 1:356 MAIN STREET ER
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-9696
Practice Address - Country:US
Practice Address - Phone:716-300-8087
Practice Address - Fax:716-358-2342
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY801646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse