Provider Demographics
NPI:1609199231
Name:HANNON, MARY BETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:390 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1250
Mailing Address - Country:US
Mailing Address - Phone:716-244-1195
Mailing Address - Fax:
Practice Address - Street 1:390 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1250
Practice Address - Country:US
Practice Address - Phone:716-244-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139891-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse