Provider Demographics
NPI:1285033159
Name:PACCIONE, MARY ANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:PACCIONE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 57TH ST STE 1450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2109
Mailing Address - Country:US
Mailing Address - Phone:347-907-1988
Mailing Address - Fax:
Practice Address - Street 1:115 E 57TH ST STE 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2109
Practice Address - Country:US
Practice Address - Phone:347-907-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338697-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily