Provider Demographics
NPI:1548787567
Name:MCCORMACK, KAREN MAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MAY
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MASSACHUSETTS AVE.
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920
Mailing Address - Country:US
Mailing Address - Phone:845-268-3735
Mailing Address - Fax:
Practice Address - Street 1:187 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920
Practice Address - Country:US
Practice Address - Phone:845-268-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189486-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse