Provider Demographics
NPI:1902241318
Name:VOLLMER, MARY ANNE (MSA,LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:VOLLMER
Suffix:
Gender:F
Credentials:MSA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4386 STONINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1580
Mailing Address - Country:US
Mailing Address - Phone:315-427-4912
Mailing Address - Fax:
Practice Address - Street 1:812 STATE FAIR BLVD
Practice Address - Street 2:LAKELAND PROFESSIONAL BLDG. SUITE3
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-1312
Practice Address - Country:US
Practice Address - Phone:315-427-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist