Provider Demographics
NPI:1861658452
Name:RICH, MARILYN ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANN
Last Name:RICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ASHFORD WAY
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9766
Mailing Address - Country:US
Mailing Address - Phone:585-742-3139
Mailing Address - Fax:
Practice Address - Street 1:700 ASHFORD WAY
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9766
Practice Address - Country:US
Practice Address - Phone:585-742-3139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332733364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health