Provider Demographics
NPI:1245302546
Name:VANCURA, MAUREEN (NP)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:VANCURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4425 OLD RIDGE RD
Mailing Address - Street 2:PO BOX 934
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9363
Mailing Address - Country:US
Mailing Address - Phone:315-483-3220
Mailing Address - Fax:315-589-4893
Practice Address - Street 1:4425 OLD RIDGE RD
Practice Address - Street 2:THE COMMONS
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9363
Practice Address - Country:US
Practice Address - Phone:315-483-3220
Practice Address - Fax:315-589-4893
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY330465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03300869Medicaid
NY03300869Medicaid