Provider Demographics
NPI:1366701054
Name:TREANOR, MARY AGNES (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:AGNES
Last Name:TREANOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:AGNES
Other - Last Name:TREANOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:20 30 150 STREET
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3637
Mailing Address - Country:US
Mailing Address - Phone:718-278-3630
Mailing Address - Fax:718-278-8312
Practice Address - Street 1:2370 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2811
Practice Address - Country:US
Practice Address - Phone:718-278-3630
Practice Address - Fax:718-278-8312
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV231034163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool