Provider Demographics
NPI:1609452788
Name:PUTMAN, MARIA ELIZABETH
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:PUTMAN
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 1:110 LEOPOLD BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-1955
Mailing Address - Country:US
Mailing Address - Phone:315-727-7817
Mailing Address - Fax:
Practice Address - Street 1:110 LEOPOLD BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1955
Practice Address - Country:US
Practice Address - Phone:315-727-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327530164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse