Individual
MR. MARY KATHERINE VANLIESHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
201 CEDAR ST, ONEIDA, NY 13421-2111
(315) 361-8413
Mailing address
138 NORTH COURT ST, WAMPSVILLE, NY 13163
(315) 366-2327
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
242891-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00569860
—
NY
Enumeration date
03/26/2009
Last updated
03/26/2009
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