Provider Demographics
NPI:1265874895
Name:KING, ANN MARY (RN)
Entity type:Individual
Prefix:MISS
First Name:ANN
Middle Name:MARY
Last Name:KING
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 1:1109 BROWN ST
Mailing Address - Street 2:APT. 2L
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3744
Mailing Address - Country:US
Mailing Address - Phone:914-930-1715
Mailing Address - Fax:
Practice Address - Street 1:1109 BROWN ST
Practice Address - Street 2:APT. 2L
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3744
Practice Address - Country:US
Practice Address - Phone:914-930-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse