=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467728410
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA A MCNAMARA RN,MSN,CPNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2012
-----------------------------------------------------
Last Update Date | 03/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 PARK AVE
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-2787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-351-2337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 SMITH ST
-----------------------------------------------------
City | MASSAPEQUA PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11762-2041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-765-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 5354001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------