Provider Demographics
NPI:1881369973
Name:OBERMEIER, MARY D (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:D
Last Name:OBERMEIER
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 1:135 BENTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3117
Mailing Address - Country:US
Mailing Address - Phone:413-525-3336
Mailing Address - Fax:
Practice Address - Street 1:135 BENTON DR
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3117
Practice Address - Country:US
Practice Address - Phone:413-525-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE58831163WI0600X
MA2314417163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control