Provider Demographics
NPI:1285924985
Name:DENNIS, MARY ELLEN (RN)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELLEN
Last Name:DENNIS
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 1:7316 199TH ST
Mailing Address - Street 2:PH
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1823
Mailing Address - Country:US
Mailing Address - Phone:516-302-3243
Mailing Address - Fax:
Practice Address - Street 1:7316 199TH ST
Practice Address - Street 2:PH
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1823
Practice Address - Country:US
Practice Address - Phone:516-302-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641051-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse