Provider Demographics
NPI:1942509757
Name:MAHAR, WILBER JR (LPN)
Entity type:Individual
Prefix:
First Name:WILBER
Middle Name:
Last Name:MAHAR
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CATHERINE ST
Mailing Address - Street 2:APT. B
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-1534
Mailing Address - Country:US
Mailing Address - Phone:315-945-2464
Mailing Address - Fax:
Practice Address - Street 1:50 CATHERINE ST
Practice Address - Street 2:APT. B
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-1534
Practice Address - Country:US
Practice Address - Phone:315-945-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246682-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse