Provider Demographics
NPI:1598199812
Name:MCCORMICK, VINCENT (CRNA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 KINSLEY ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3634
Mailing Address - Country:US
Mailing Address - Phone:603-882-1501
Mailing Address - Fax:603-882-9747
Practice Address - Street 1:168 KINSLEY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3634
Practice Address - Country:US
Practice Address - Phone:603-882-1501
Practice Address - Fax:603-882-9747
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068142-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered