Provider Demographics
NPI:1376775478
Name:CAPPARELLI, MARY M (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:CAPPARELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4042
Mailing Address - Country:US
Mailing Address - Phone:585-305-8849
Mailing Address - Fax:
Practice Address - Street 1:837 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4042
Practice Address - Country:US
Practice Address - Phone:585-305-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF410036-1363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool