Individual
MARY ANN LICWINKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8835 GERMANTOWN AVE, PHILADELPHIA, PA 19118-2718
(215) 248-8200
Mailing address
68 S SERVICE RD, SUITE 350, MELVILLE, NY 11747-2358
(516) 945-3347
(516) 945-3131
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
187701L
PA
Other
Enumeration date
07/09/2006
Last updated
03/25/2015
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