Provider Demographics
NPI:1114178506
Name:COLE, MARY LOUISE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LOUISE
Last Name:COLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SAINT JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2013
Mailing Address - Country:US
Mailing Address - Phone:585-720-1749
Mailing Address - Fax:
Practice Address - Street 1:66 SAINT JOHNS DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2013
Practice Address - Country:US
Practice Address - Phone:585-720-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433970-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse