Provider Demographics
NPI:1770857187
Name:MCCOY, CAROL LINETTE
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:LINETTE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:LINETTE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:783 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609
Mailing Address - Country:US
Mailing Address - Phone:585-201-4145
Mailing Address - Fax:
Practice Address - Street 1:783 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-201-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236378-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse