Provider Demographics
NPI:1346780079
Name:VIRGINIA MAHNKEN MS, RN
Entity type:Organization
Organization Name:VIRGINIA MAHNKEN MS, RN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHNKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN
Authorized Official - Phone:631-317-3085
Mailing Address - Street 1:475 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8205
Mailing Address - Country:US
Mailing Address - Phone:631-317-3085
Mailing Address - Fax:631-317-3085
Practice Address - Street 1:475 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8205
Practice Address - Country:US
Practice Address - Phone:631-317-3085
Practice Address - Fax:631-317-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399791-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163WHO200XMedicaid