Provider Demographics
NPI:1619129434
Name:MCCORMACK, PATRICIA ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5828
Mailing Address - Country:US
Mailing Address - Phone:845-614-5024
Mailing Address - Fax:
Practice Address - Street 1:357 OAK DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5828
Practice Address - Country:US
Practice Address - Phone:845-614-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse