MEDICARE: MR. WILLIAM C MCCONNELL 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	544418-1	NY

General Provider Information

NPI Number	:	1588943369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM C MCCONNELL RN

Provider Business Mailing Address
First Line	:	8 BAY ST
Second Line	:
City	:	EAST MORICHES
State	:	NY
Zip	:	11940-1514
Country	:	US
Telephone Number	:	631-807-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 BAY ST
Second Line	:
City	:	EAST MORICHES
State	:	NY
Zip	:	11940-1514
Country	:	US
Telephone Number	:	631-807-8921
Fax Number	:

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

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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