Provider Demographics
NPI:1780123299
Name:MCBEAN, KEMONE NICHISHA
Entity type:Individual
Prefix:
First Name:KEMONE
Middle Name:NICHISHA
Last Name:MCBEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S 4TH AVE
Mailing Address - Street 2:1B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4475
Mailing Address - Country:US
Mailing Address - Phone:914-689-6601
Mailing Address - Fax:
Practice Address - Street 1:1230 ZEREGA AVENUE
Practice Address - Street 2:NEW YORK DEPARTMENT OF EDUCATION
Practice Address - City:10462
Practice Address - State:NY
Practice Address - Zip Code:10550-4475
Practice Address - Country:US
Practice Address - Phone:718-828-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY652020163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse