Provider Demographics
NPI:1124653662
Name:MCCAULEY, LYNETTE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MARIE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9734
Mailing Address - Country:US
Mailing Address - Phone:585-406-6872
Mailing Address - Fax:
Practice Address - Street 1:4988 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9734
Practice Address - Country:US
Practice Address - Phone:585-406-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2373781164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse