Provider Demographics
NPI:1467750075
Name:HOUSE CALLS NURSE PRACTITIONER IN GERONTOLOGY
Entity Type:Organization
Organization Name:HOUSE CALLS NURSE PRACTITIONER IN GERONTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NP-C
Authorized Official - Phone:631-365-2095
Mailing Address - Street 1:22 GLENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2402
Mailing Address - Country:US
Mailing Address - Phone:631-365-2095
Mailing Address - Fax:855-735-8332
Practice Address - Street 1:22 GLENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2402
Practice Address - Country:US
Practice Address - Phone:631-365-2095
Practice Address - Fax:855-735-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340207363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty