Mary Jane Fowler, LPN

Individual provider Active NPI Licensed Practical Nurse · Greece, NY

NPI 1487933537 · NPPES record last updated Aug 8, 2011

Key facts

NPI
1487933537
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
217801-1 (NY)
Practice address
181 Rodessa Rd
Greece, NY 14616-4605
Phone
(585) 755-7992
NPI assigned
Aug 8, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
217801-1NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 217801-1 NY Yes

Addresses

Primary practice location

181 Rodessa Rd
Greece, NY 14616-4605

Mailing address

181 Rodessa Rd
Greece, NY 14616-4605
Phone (585) 755-7992

Other providers in Greece, NY

All providers in Greece, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.