Individual
BEVERLY WAKEFIELD MACAULEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
110 E BROADWAY, PORT JEFFERSON, NY 11777-1245
(631) 928-4153
(631) 928-4153
Mailing address
110 E BROADWAY, PORT JEFFERSON, NY 11777-1245
(631) 928-4153
(631) 928-4153
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
171425-1
NY
Other
Enumeration date
11/21/2008
Last updated
11/21/2008
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