Provider Demographics
NPI:1396133153
Name:MCCARTHY, VERONICA ANN
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:ANN
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:66 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012-9502
Mailing Address - Country:US
Mailing Address - Phone:269-491-0649
Mailing Address - Fax:
Practice Address - Street 1:66 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:MI
Practice Address - Zip Code:49012-9502
Practice Address - Country:US
Practice Address - Phone:269-491-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2601001069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist