Provider Demographics
NPI:1003113911
Name:KNIFFI, MAXINE MARGARET (RN, MSN)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:MARGARET
Last Name:KNIFFI
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 ROUTE 364
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9359
Mailing Address - Country:US
Mailing Address - Phone:607-595-2857
Mailing Address - Fax:
Practice Address - Street 1:3773 ROUTE 364
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-9359
Practice Address - Country:US
Practice Address - Phone:607-595-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415955163W00000X, 163WC3500X, 163WH0200X, 163WH1000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMMK6446Medicaid
NYMMK6446Medicare UPIN
NYMMK6446Medicare PIN
NYMMK6446Medicaid
NY6446123456Medicare NSC