Provider Demographics
NPI:1568753382
Name:PARAWAN, MARY ROSE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:PARAWAN
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 1:94 EAST 57TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:917-721-5135
Mailing Address - Fax:718-485-9502
Practice Address - Street 1:94 E 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3731
Practice Address - Country:US
Practice Address - Phone:917-721-5135
Practice Address - Fax:718-485-9502
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22386043163W00000X, 163WC2100X, 163WD0400X, 163WH0200X, 163WI0500X, 163WI0600X, 163WM0705X, 163WR0006X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01641074Medicaid