Provider Demographics
NPI:1538650841
Name:KLEINER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KLEINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1480
Mailing Address - Country:US
Mailing Address - Phone:570-387-2474
Mailing Address - Fax:570-387-2397
Practice Address - Street 1:425 E 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1480
Practice Address - Country:US
Practice Address - Phone:570-387-2474
Practice Address - Fax:570-387-2397
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN260573L163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory