Individual
MRS. MARY THEODORA OBERHOLTZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
845 W GENESEE RD, HOMECARE VARIES, PLAINVILLE, NY 13137
(315) 638-2984
Mailing address
1540 GLENWOOD AVE, SYRACUSE, NY 13207-1011
(315) 476-1771
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
2844581
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01243998
—
NY
Enumeration date
05/08/2007
Last updated
07/08/2007
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