Provider Demographics
NPI:1922738814
Name:BASCO, MARY ANTONNETTE CANO (BSN, RN, CCRN, SRNA)
Entity Type:Individual
Prefix:
First Name:MARY ANTONNETTE
Middle Name:CANO
Last Name:BASCO
Suffix:
Gender:F
Credentials:BSN, RN, CCRN, SRNA
Other - Prefix:
Other - First Name:MARY ANTONNETTE
Other - Middle Name:CANO
Other - Last Name:MADDELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 E 70TH ST APT 11A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5341
Mailing Address - Country:US
Mailing Address - Phone:516-508-1056
Mailing Address - Fax:
Practice Address - Street 1:560 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3917
Practice Address - Country:US
Practice Address - Phone:212-305-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556377163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine