Provider Demographics
NPI:1104157924
Name:PARRISH, MARYANN ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:ELIZABETH
Last Name:PARRISH
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 1:40 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1316
Mailing Address - Country:US
Mailing Address - Phone:631-732-0175
Mailing Address - Fax:
Practice Address - Street 1:40 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1316
Practice Address - Country:US
Practice Address - Phone:631-732-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507423-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY507423-1Medicaid