Provider Demographics
NPI:1184952699
Name:CLUNIE, CAROL PATRICIA
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:PATRICIA
Last Name:CLUNIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:PATRICIA
Other - Last Name:HASKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1107
Mailing Address - Country:US
Mailing Address - Phone:516-532-7601
Mailing Address - Fax:
Practice Address - Street 1:19 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1107
Practice Address - Country:US
Practice Address - Phone:516-532-7601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263558164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse