Healthcare Provider Details

I. General information

NPI: 1336804228
Provider Name (Legal Business Name): CAROL ANN MAYE RN/BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 WESTINGHOUSE RD
HORSEHEADS NY
14845-8196
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2499
US

V. Phone/Fax

Practice location:
  • Phone: 607-796-2673
  • Fax:
Mailing address:
  • Phone: 800-748-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number326549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: