MEDICARE: JACQUELINE MULCAHY 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	391602-1	NY

General Provider Information

NPI Number	:	1912216839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MULCAHY RN

Provider Business Mailing Address
First Line	:	425 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2914
Country	:	US
Telephone Number	:	518-824-2603
Fax Number	:	518-824-2680

Provider Business Practice Location Address
First Line	:	425 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2914
Country	:	US
Telephone Number	:	518-824-2603
Fax Number	:	518-824-2680

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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