MEDICARE: EMMELINE FOURCAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	706323	NY
2	164W00000X	Licensed Practical Nurse	10 311160	NY
3	163WP0808X	Psychiatric/Mental Health Registered Nurse	706323	NY

General Provider Information

NPI Number	:	1124370994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMELINE FOURCAND

Provider Business Mailing Address
First Line	:	11668 232ND ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1834
Country	:	US
Telephone Number	:	718-749-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	11668 232ND ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1834
Country	:	US
Telephone Number	:	718-749-3015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	04/09/2019

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Directions to “ EMMELINE FOURCAND ” Practice Location

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