Provider Demographics
NPI:1104987411
Name:MUCK, DEE ANN (LPN)
Entity type:Individual
Prefix:
First Name:DEE
Middle Name:ANN
Last Name:MUCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 RICE RD
Mailing Address - Street 2:
Mailing Address - City:HIMROD
Mailing Address - State:NY
Mailing Address - Zip Code:14842-9728
Mailing Address - Country:US
Mailing Address - Phone:607-243-7720
Mailing Address - Fax:
Practice Address - Street 1:733 RICE RD
Practice Address - Street 2:
Practice Address - City:HIMROD
Practice Address - State:NY
Practice Address - Zip Code:14842-9728
Practice Address - Country:US
Practice Address - Phone:607-243-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282482-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY282482-1OtherNYS LPN LICENSE NUMBER
NY02707826Medicaid