Provider Demographics
NPI:1598994071
Name:MC CARTY, KATHLEEN MAVOURNEEN (RN, APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAVOURNEEN
Last Name:MC CARTY
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BEARFORT TER
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2952
Mailing Address - Country:US
Mailing Address - Phone:973-962-1853
Mailing Address - Fax:
Practice Address - Street 1:66 BEARFORT TER
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2952
Practice Address - Country:US
Practice Address - Phone:973-962-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06753200163WC0400X
NJ26NC06753200163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management