Provider Demographics
NPI:1528403292
Name:MULGRAVE, DENZIL A (RN)
Entity Type:Individual
Prefix:MR
First Name:DENZIL
Middle Name:A
Last Name:MULGRAVE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5533
Mailing Address - Country:US
Mailing Address - Phone:516-589-2977
Mailing Address - Fax:
Practice Address - Street 1:1076 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5533
Practice Address - Country:US
Practice Address - Phone:516-589-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666555163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health