Provider Demographics
NPI:1053051631
Name:PELKEY, MARIAH M (LPN)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:M
Last Name:PELKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 POST RD APT 1105
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7000
Mailing Address - Country:US
Mailing Address - Phone:401-585-3226
Mailing Address - Fax:
Practice Address - Street 1:56 ITITCHING POST DRIVE
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:401-585-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPN12110164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty