Provider Demographics
NPI:1629346176
Name:WYBORSKI-WATERS, MARY M (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:WYBORSKI-WATERS
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 1:293 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3804
Mailing Address - Country:US
Mailing Address - Phone:315-272-2600
Mailing Address - Fax:315-337-0675
Practice Address - Street 1:195-199 W DOMININCK ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-272-2730
Practice Address - Fax:315-337-0675
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552736-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health