MEDICARE: KERRY JEAN MCQUAIR RN

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	45804001	NY

General Provider Information

NPI Number	:	1366106726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY JEAN MCQUAIR RN

Provider Business Mailing Address
First Line	:	17 SAINT JAMES PL
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2237
Country	:	US
Telephone Number	:	516-445-3543
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SAINT JAMES PL
Second Line	:
City	:	GLEN COVE
State	:	NY
Zip	:	11542-2237
Country	:	US
Telephone Number	:	516-445-3543
Fax Number	:

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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