Healthcare Provider Details

I. General information

NPI: 1154894640
Provider Name (Legal Business Name): KATHLEEN PATRICE MAGUIRE MSN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

1235 PARK AVE APT PH
NEW YORK NY
10128-1759
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2842
  • Fax:
Mailing address:
  • Phone: 917-843-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number350128-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: