Healthcare Provider Details

I. General information

NPI: 1396023180
Provider Name (Legal Business Name): KATHYRON ANN MAINE MS, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LODER ST STE A
HORNELL NY
14843-1950
US

IV. Provider business mailing address

111 LODER ST STE A
HORNELL NY
14843-1950
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-5404
  • Fax: 607-324-5463
Mailing address:
  • Phone: 607-324-5404
  • Fax: 607-324-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: