Provider Demographics
NPI:1891018487
Name:MCMAHON, AGNES JOSEPHINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:JOSEPHINE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SICKLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2864
Mailing Address - Country:US
Mailing Address - Phone:845-620-9450
Mailing Address - Fax:
Practice Address - Street 1:2 SICKLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2864
Practice Address - Country:US
Practice Address - Phone:845-620-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2385131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse