Provider Demographics
NPI:1629390349
Name:WOODRUFF, MARYANN J (LPN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:J
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:J
Other - Last Name:FANCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2839 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-9641
Mailing Address - Country:US
Mailing Address - Phone:585-307-6331
Mailing Address - Fax:
Practice Address - Street 1:1355 OLEAN PORTVILLE RD
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-9416
Practice Address - Country:US
Practice Address - Phone:716-373-0021
Practice Address - Fax:716-373-1710
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276640-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161039939OtherALL OTHER INSURANCES
NY161039939Medicaid