Provider Demographics
NPI:1043520406
Name:WOLLNEY, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:WOLLNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 S OCEAN BLVD
Mailing Address - Street 2:#701
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-5469
Mailing Address - Country:US
Mailing Address - Phone:561-493-9701
Mailing Address - Fax:
Practice Address - Street 1:2560 S OCEAN BLVD
Practice Address - Street 2:#701
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-5469
Practice Address - Country:US
Practice Address - Phone:561-493-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA182971376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide