Provider Demographics
NPI:1437936689
Name:MCTAVISH, MICHAEL NUGENT (CNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NUGENT
Last Name:MCTAVISH
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NAVAJO CT
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3019
Mailing Address - Country:US
Mailing Address - Phone:857-258-5260
Mailing Address - Fax:508-300-0236
Practice Address - Street 1:99 NAVAJO CT
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3019
Practice Address - Country:US
Practice Address - Phone:857-258-5260
Practice Address - Fax:508-300-0236
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide