Provider Demographics
NPI:1730803636
Name:MCEWEN, PAULETTE PATRICIA (CRPA)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:PATRICIA
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHESTNUT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2303
Mailing Address - Country:US
Mailing Address - Phone:585-262-4330
Mailing Address - Fax:585-510-4797
Practice Address - Street 1:33 CHESTNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2303
Practice Address - Country:US
Practice Address - Phone:585-262-4330
Practice Address - Fax:585-510-4797
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-5370175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1891903787OtherOUT PATIENT