Provider Demographics
NPI:1497969612
Name:RADIMER, MARY C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:RADIMER
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 1:1463 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2312
Mailing Address - Country:US
Mailing Address - Phone:518-359-2159
Mailing Address - Fax:
Practice Address - Street 1:1463 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2312
Practice Address - Country:US
Practice Address - Phone:518-359-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY371722-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284743OtherPRIVATE DUTY NURSE