Provider Demographics
NPI:1023764487
Name:MCCARGAR, MICHAELA DUFFY (FNP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:DUFFY
Last Name:MCCARGAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23663 COUNTY ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634-2075
Mailing Address - Country:US
Mailing Address - Phone:315-836-5162
Mailing Address - Fax:
Practice Address - Street 1:19472 US-11
Practice Address - Street 2:SUITE N 101
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty