Provider Demographics
NPI:1083939672
Name:STREIBL, MARY M (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:M
Last Name:STREIBL
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 1:17 FORGE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PORT HENRY
Mailing Address - State:NY
Mailing Address - Zip Code:12974-1512
Mailing Address - Country:US
Mailing Address - Phone:518-546-7763
Mailing Address - Fax:
Practice Address - Street 1:17 FORGE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974-1512
Practice Address - Country:US
Practice Address - Phone:518-546-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0647811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse