Provider Demographics
NPI:1063603728
Name:CUMMISKEY, JOAN MARIE (RN)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:CUMMISKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:CUMMISKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0193
Mailing Address - Country:US
Mailing Address - Phone:314-808-1639
Mailing Address - Fax:
Practice Address - Street 1:5 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-933-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse