=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386130128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIA LYNNE MCCORMICK NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2018
-----------------------------------------------------
Last Update Date | 04/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 EAST MAIN STREET
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-849-3271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 S WEST ST
-----------------------------------------------------
City | HOMER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13077-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-753-3797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 343261
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------