Provider Demographics
NPI:1306144993
Name:MACKOUL, SHARON L (LPN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:MACKOUL
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 1:104 STRATHMORE COURT DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1607
Mailing Address - Country:US
Mailing Address - Phone:631-928-1709
Mailing Address - Fax:
Practice Address - Street 1:104 STRATHMORE COURT DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1607
Practice Address - Country:US
Practice Address - Phone:631-928-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245873-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse