Provider Demographics
NPI:1811290406
Name:MCNINCH, MARY JO (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:MCNINCH
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 1:2 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:14813-9548
Mailing Address - Country:US
Mailing Address - Phone:585-268-5267
Mailing Address - Fax:
Practice Address - Street 1:2 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NY
Practice Address - Zip Code:14813-9548
Practice Address - Country:US
Practice Address - Phone:585-268-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4561691163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health