Provider Demographics
NPI:1801223417
Name:ABDULLAH, MARYANN A (RN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:A
Last Name:ABDULLAH
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 1:1 N MOELLER ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1920
Mailing Address - Country:US
Mailing Address - Phone:607-771-1004
Mailing Address - Fax:607-771-1004
Practice Address - Street 1:1 N MOELLER ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1920
Practice Address - Country:US
Practice Address - Phone:607-771-1004
Practice Address - Fax:607-771-1004
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453402163W00000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator