Provider Demographics
NPI:1760792089
Name:MCPHAUL, JANICE PATRICIA (RN)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:PATRICIA
Last Name:MCPHAUL
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 1:188 LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3538
Mailing Address - Country:US
Mailing Address - Phone:631-219-6715
Mailing Address - Fax:
Practice Address - Street 1:188 LEAF AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3538
Practice Address - Country:US
Practice Address - Phone:631-219-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291236164W00000X
NY869694-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse