Provider Demographics
NPI:1912216839
Name:MULCAHY, JACQUELINE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MULCAHY
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 1:425 AVIATION RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2914
Mailing Address - Country:US
Mailing Address - Phone:518-824-2603
Mailing Address - Fax:518-824-2680
Practice Address - Street 1:425 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2914
Practice Address - Country:US
Practice Address - Phone:518-824-2603
Practice Address - Fax:518-824-2680
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391602-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse