MEDICARE: ETHELIA MCKAY

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	367500000X	Certified Registered Nurse Anesthetist	421768	NY

General Provider Information

NPI Number	:	1487699054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHELIA MCKAY

Provider Business Mailing Address
First Line	:	744 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1909
Country	:	US
Telephone Number	:	517-787-6440
Fax Number	:	517-787-4146

Provider Business Practice Location Address
First Line	:	9002 QUEENS BLVD
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4941
Country	:	US
Telephone Number	:	718-558-1870
Fax Number	:

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	09/06/2023

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