Provider Demographics
NPI:1609375062
Name:NELLIGAN, THERESE WALKER (RN)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:WALKER
Last Name:NELLIGAN
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 1:306 PLEASANT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1816
Mailing Address - Country:US
Mailing Address - Phone:315-481-1294
Mailing Address - Fax:
Practice Address - Street 1:306 PLEASANT ST APT 3
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1816
Practice Address - Country:US
Practice Address - Phone:315-481-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561574163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health