Healthcare Provider Details

I. General information

NPI: 1134406945
Provider Name (Legal Business Name): CAROL WAYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KENNEDY PKWY
CORTLAND NY
13045-1409
US

IV. Provider business mailing address

22 ABDALLAH AVE
CORTLAND NY
13045-3303
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9105
  • Fax:
Mailing address:
  • Phone: 607-423-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number409878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: