Provider Demographics
NPI:1699338111
Name:LUTHER, MARGARET ROSE (RN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:LUTHER
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 1:33 CHURCH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1761
Mailing Address - Country:US
Mailing Address - Phone:716-785-6335
Mailing Address - Fax:716-785-6138
Practice Address - Street 1:33 CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1761
Practice Address - Country:US
Practice Address - Phone:716-785-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350675-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse