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NPI Code Detail

MEDICARE: THERESA MCPHERSON

MEDICARE: THERESA MCPHERSON
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
1164W00000XLicensed Practical Nurse256728NY

General Provider Information

NPI Number : 1710533567
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA MCPHERSON
Provider Business Mailing Address
First Line : 14202 20TH AVE FL 3
Second Line :
City : FLUSHING
State : NY
Zip : 11351-3000
Country : US
Telephone Number : 718-559-0516
Fax Number :
Provider Business Practice Location Address
First Line : 10154 117TH ST
Second Line :
City : SOUTH RICHMOND HILL
State : NY
Zip : 11419-1906
Country : US
Telephone Number : 718-846-4007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2019
Last Update Date : 08/16/2019

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