Provider Demographics
NPI:1164466710
Name:RAPPOLE, MARY H (RN,MSN,NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:RAPPOLE
Suffix:
Gender:F
Credentials:RN,MSN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:CHAUTAUQUA
Mailing Address - State:NY
Mailing Address - Zip Code:14722-1105
Mailing Address - Country:US
Mailing Address - Phone:716-499-4467
Mailing Address - Fax:
Practice Address - Street 1:20 W FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1702
Practice Address - Country:US
Practice Address - Phone:716-338-0033
Practice Address - Fax:716-338-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331985-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2430404Medicaid
NY2430404Medicaid
NY2430404Medicaid