Provider Demographics
NPI:1619316619
Name:WALDRON, JOHNAELLYN F (RN)
Entity Type:Individual
Prefix:MS
First Name:JOHNAELLYN
Middle Name:F
Last Name:WALDRON
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 1:733 COUNTY ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:NY
Mailing Address - Zip Code:13074-2348
Mailing Address - Country:US
Mailing Address - Phone:315-806-7523
Mailing Address - Fax:
Practice Address - Street 1:733 COUNTY ROUTE 7
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:NY
Practice Address - Zip Code:13074-2348
Practice Address - Country:US
Practice Address - Phone:315-806-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY557631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse