Provider Demographics
NPI:1871746065
Name:ANDOLINA, MARYANN (BS,RN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:ANDOLINA
Suffix:
Gender:F
Credentials:BS,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 LEE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4257
Mailing Address - Country:US
Mailing Address - Phone:585-368-4560
Mailing Address - Fax:585-368-4565
Practice Address - Street 1:687 LEE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4257
Practice Address - Country:US
Practice Address - Phone:585-368-4560
Practice Address - Fax:585-368-4565
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230161163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator