Provider Demographics
NPI:1962725861
Name:SHOWERS, MARIETA (LPN)
Entity type:Individual
Prefix:
First Name:MARIETA
Middle Name:
Last Name:SHOWERS
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 1:5682 PLUM BROOK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14741-9755
Mailing Address - Country:US
Mailing Address - Phone:716-699-2290
Mailing Address - Fax:
Practice Address - Street 1:700 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2346
Practice Address - Country:US
Practice Address - Phone:716-373-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120553164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse