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NPI Code Detail

MEDICARE: MARY KRESSER

MEDICARE: MARY KRESSER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse258284NY

General Provider Information

NPI Number : 1205474772
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KRESSER
Provider Business Mailing Address
First Line : 214 LAFAYETTE RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13205-2921
Country : US
Telephone Number : 315-729-8730
Fax Number :
Provider Business Practice Location Address
First Line : 214 LAFAYETTE RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13205-2921
Country : US
Telephone Number : 315-729-8730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2019
Last Update Date : 12/16/2019

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Directions to “ MARY KRESSER ” Practice Location

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