Basic Information
| Provider Information | |||||||||
| NPI: | 1245302546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANCURA | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 OLD RIDGE RD | ||||||||
| Address2: | PO BOX 934 | ||||||||
| City: | WILLIAMSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145899363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154833220 | ||||||||
| FaxNumber: | 3155894893 | ||||||||
| Practice Location | |||||||||
| Address1: | 4425 OLD RIDGE RD | ||||||||
| Address2: | THE COMMONS | ||||||||
| City: | WILLIAMSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145899363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154833220 | ||||||||
| FaxNumber: | 3155894893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 04/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 330465 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 03300869 | 05 | NY | MEDICAID |