Provider Demographics
NPI:1417104688
Name:UTTECH, MARY JANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:UTTECH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY JANE
Other - Middle Name:
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:60 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2746
Mailing Address - Country:US
Mailing Address - Phone:607-753-5139
Mailing Address - Fax:607-753-5209
Practice Address - Street 1:60 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2746
Practice Address - Country:US
Practice Address - Phone:607-753-5139
Practice Address - Fax:607-753-5209
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242403163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse