Provider Demographics
NPI:1487724944
Name:KREBBEKS, MARY ANN (APRN,NP)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:KREBBEKS
Suffix:
Gender:F
Credentials:APRN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 SHIREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2135
Mailing Address - Country:US
Mailing Address - Phone:585-329-9336
Mailing Address - Fax:
Practice Address - Street 1:40 OFFICE PARK WAY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1738
Practice Address - Country:US
Practice Address - Phone:585-329-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400708-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400708-1OtherNURSE PRACTIONER LICENSE