Provider Demographics
NPI:1215761937
Name:MCCAULEY, JOANNE JEAN
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:JEAN
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 STATE ROUTE 79
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-2717
Mailing Address - Country:US
Mailing Address - Phone:607-221-7564
Mailing Address - Fax:
Practice Address - Street 1:740 STATE ROUTE 79
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-2717
Practice Address - Country:US
Practice Address - Phone:607-221-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350977164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse