Provider Demographics
NPI:1619325735
Name:MANN, MARCY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 HADDEN RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:NY
Mailing Address - Zip Code:13146-9778
Mailing Address - Country:US
Mailing Address - Phone:315-365-2170
Mailing Address - Fax:
Practice Address - Street 1:1848 HADDEN RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:NY
Practice Address - Zip Code:13146-9778
Practice Address - Country:US
Practice Address - Phone:315-365-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242779164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse