Provider Demographics
NPI:1972076164
Name:D'ONOFRIO, MARYANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:D'ONOFRIO
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 1:54 ANCHOR CT
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7235
Mailing Address - Country:US
Mailing Address - Phone:631-661-2827
Mailing Address - Fax:
Practice Address - Street 1:54 ANCHOR CT
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7235
Practice Address - Country:US
Practice Address - Phone:631-661-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396503-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY396503-1OtherRN LICENSE