Provider Demographics
NPI:1861778490
Name:NORTHRUP, MARY K (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:NORTHRUP
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 1:20 ENFIELD MAIN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9367
Mailing Address - Country:US
Mailing Address - Phone:607-274-2335
Mailing Address - Fax:607-274-6810
Practice Address - Street 1:20 ENFIELD MAIN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9367
Practice Address - Country:US
Practice Address - Phone:607-274-2335
Practice Address - Fax:607-274-6810
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506318163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool