Healthcare Provider Details

I. General information

NPI: 1265664213
Provider Name (Legal Business Name): MAHRIE AMELIA MOORE HYLAND CNM, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ARROWOOD DR
ITHACA NY
14850-1857
US

IV. Provider business mailing address

20 ARROWOOD DR
ITHACA NY
14850-1857
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-7800
  • Fax: 607-216-0093
Mailing address:
  • Phone: 607-266-7800
  • Fax: 607-216-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001350
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346551
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: