Provider Demographics
NPI:1841351988
Name:WARNER, MARY E (GERIATRIC NURSE PRAC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:WARNER
Suffix:
Gender:F
Credentials:GERIATRIC NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:39 ALBANY STREET
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-0251
Mailing Address - Country:US
Mailing Address - Phone:607-843-6636
Mailing Address - Fax:
Practice Address - Street 1:4211 STATE HIGHWAY 220
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830
Practice Address - Country:US
Practice Address - Phone:607-843-3139
Practice Address - Fax:607-843-3162
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
541150Medicare UPIN
NYDD5710Medicare ID - Type Unspecified