Healthcare Provider Details

I. General information

NPI: 1699079111
Provider Name (Legal Business Name): MARY CREIGHTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CLOVER DR PUPIL PERSONAL SERVICES-GREAT NECK PUBLIC SCHOOLS
GREAT NECK NY
11021-1031
US

IV. Provider business mailing address

105 CLOVER DR PUPIL PERSONAL SERVICES-GREAT NECK PUBLIC SCHOOLS
GREAT NECK NY
11021-1031
US

V. Phone/Fax

Practice location:
  • Phone: 516-441-4270
  • Fax:
Mailing address:
  • Phone: 516-441-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number317985-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: