Provider Demographics
NPI:1538726096
Name:FARLEY, MARY E
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-0200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748-1136
Practice Address - Country:US
Practice Address - Phone:607-775-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454869163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool