Provider Demographics
NPI:1629390349
Name:FANCHER, MARYANN JOY (LPN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:JOY
Last Name:FANCHER
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:NY
Mailing Address - Zip Code:14101-0254
Mailing Address - Country:US
Mailing Address - Phone:716-258-8021
Mailing Address - Fax:
Practice Address - Street 1:21 MILL ST
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9703
Practice Address - Country:US
Practice Address - Phone:716-258-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276640164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse