Healthcare Provider Details

I. General information

NPI: 1841796224
Provider Name (Legal Business Name): PATRICIA MCCARTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 TWIN PEAKS RD SE
ALBUQUERQUE NM
87123-3906
US

IV. Provider business mailing address

49 TWIN PEAKS RD SE
ALBUQUERQUE NM
87123-3906
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-9373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR29305
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: