Healthcare Provider Details

I. General information

NPI: 1326315581
Provider Name (Legal Business Name): LYNETTE MCCURCHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 N GARDINER DR
BAY SHORE NY
11706-1411
US

IV. Provider business mailing address

1583 N GARDINER DR
BAY SHORE NY
11706-1411
US

V. Phone/Fax

Practice location:
  • Phone: 631-813-2006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number415906-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: