Provider Demographics
NPI:1780006205
Name:MCKAY, BERNADETTE (RN)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MCKAY
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 1:168 BOYLE RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1948
Mailing Address - Country:US
Mailing Address - Phone:631-696-5124
Mailing Address - Fax:
Practice Address - Street 1:168 BOYLE RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1948
Practice Address - Country:US
Practice Address - Phone:631-696-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307145-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse