Provider Demographics
NPI:1225394349
Name:MAHONEY, ANN THERESA (RN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:THERESA
Last Name:MAHONEY
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 1:91 FIDDLERS LN
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5349
Mailing Address - Country:US
Mailing Address - Phone:518-785-8591
Mailing Address - Fax:
Practice Address - Street 1:91 FIDDLERS LN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5349
Practice Address - Country:US
Practice Address - Phone:518-785-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252826163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool