Provider Demographics
NPI:1164064291
Name:WAHL, MARIA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:J
Last Name:WAHL
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 1:2173 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9756
Mailing Address - Country:US
Mailing Address - Phone:716-948-6965
Mailing Address - Fax:
Practice Address - Street 1:141 HOYT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1622
Practice Address - Country:US
Practice Address - Phone:716-816-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677088-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool