Healthcare Provider Details

I. General information

NPI: 1154191179
Provider Name (Legal Business Name): NANCY ANNA MAHR-TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CONTINUUM DR
LIVERPOOL NY
13088-4387
US

IV. Provider business mailing address

4517 WILCOX PL
JAMESVILLE NY
13078-9531
US

V. Phone/Fax

Practice location:
  • Phone: 315-450-4898
  • Fax: 315-449-9898
Mailing address:
  • Phone: 315-415-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: