Provider Demographics
NPI:1215113071
Name:MCGOLDRICK, SUSAN (LPN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MCGOLDRICK
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 1:322 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2022
Mailing Address - Country:US
Mailing Address - Phone:716-444-1802
Mailing Address - Fax:
Practice Address - Street 1:322 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2022
Practice Address - Country:US
Practice Address - Phone:716-444-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189108-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse