Provider Demographics
NPI:1437474715
Name:SCROCCO, MARY CAROL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROL
Last Name:SCROCCO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROL
Other - Last Name:NOONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:POD 154
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-0000
Mailing Address - Country:US
Mailing Address - Phone:716-898-3388
Mailing Address - Fax:716-898-4532
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:POD 154
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-0000
Practice Address - Country:US
Practice Address - Phone:716-898-3388
Practice Address - Fax:716-898-4532
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330647-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily