Individual
MRS. MARY C RADIMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
1463 STATE ROUTE 30, TUPPER LAKE, NY 12986-2312
(518) 359-2159
Mailing address
1463 STATE ROUTE 30, TUPPER LAKE, NY 12986-2312
(518) 359-2159
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
371722-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01284743
PRIVATE DUTY NURSE
NY
Enumeration date
05/09/2007
Last updated
07/08/2007
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