Provider Demographics
NPI:1669941431
Name:WHITE-FERRIS, MARY E
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WHITE-FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-2300
Mailing Address - Country:US
Mailing Address - Phone:518-873-6377
Mailing Address - Fax:518-873-3097
Practice Address - Street 1:75 PARK STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-2300
Practice Address - Country:US
Practice Address - Phone:518-873-6377
Practice Address - Fax:518-873-3097
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY387765163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator