Mary Mandelis
Individual provider Active NPI Licensed Practical Nurse · De Witt, NY
NPI 1831592237 · NPPES record last updated Sep 30, 2014
Key facts
- NPI
- 1831592237
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 319757-1 (NY)
- Practice address
- 214 Wellington Rd
De Witt, NY 13214-2226 - Phone
- (315) 299-4594
- NPI assigned
- Sep 30, 2014
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 319757-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 319757-1 | NY | Yes |
Addresses
Primary practice location
214 Wellington Rd
De Witt, NY 13214-2226
Mailing address
214 Wellington Rd
De Witt, NY 13214-2226
Phone (315) 299-4594
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All providers in De Witt, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.