Provider Demographics
NPI:1457762742
Name:FAUGHNAN, MARYGRACE (RN)
Entity Type:Individual
Prefix:
First Name:MARYGRACE
Middle Name:
Last Name:FAUGHNAN
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 1:3758 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2101
Mailing Address - Country:US
Mailing Address - Phone:516-557-7357
Mailing Address - Fax:516-679-8873
Practice Address - Street 1:3758 CLARK ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2101
Practice Address - Country:US
Practice Address - Phone:516-557-7357
Practice Address - Fax:516-679-8873
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator