Provider Demographics
NPI:1043599681
Name:MCEWEN, STEPHANIE KATHLEEN (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KATHLEEN
Last Name:MCEWEN
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 1:150 CEDAR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2806
Mailing Address - Country:US
Mailing Address - Phone:315-561-0439
Mailing Address - Fax:
Practice Address - Street 1:150 CEDAR ST APT 1
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2806
Practice Address - Country:US
Practice Address - Phone:315-561-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292878-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse