| Doctor Name: | MRS. MARY C RADIMER |
| NPI Number: | 1497969612 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 371722-1 |
| Business Practice Address: | 1463 State Route 30 Tupper Lake, NY - 129862312 |
| Business Phone Number: | 5183592159 |
| Business Fax Number: | |
| Mailing Address: | 1463 State Route 30, TUPPER LAKE |
| State: | NY |
| Postal Code: | 129862312 |
| Phone Number: | 5183592159 |
| Fax Number: | |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 371722-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |