Provider Demographics
NPI:1912289901
Name:KLOCKOWSKI, MARY ZAENGLE (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ZAENGLE
Last Name:KLOCKOWSKI
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 1:155 THOMPSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3543
Mailing Address - Country:US
Mailing Address - Phone:607-334-8724
Mailing Address - Fax:
Practice Address - Street 1:89 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1948
Practice Address - Country:US
Practice Address - Phone:607-334-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22475712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse