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General NPI Number Information
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NPI Number | 1639882327
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Entity Type | Individual
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Provider Name | CHELSEA RENEE MAYCUMBER AGNP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 600 ROE AVE
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City | ELMIRA
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State | NY
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Zip | 14905-1676
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Country | US
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Telephone | 607-737-4141
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Fax | 607-737-8166
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Provider Business Mailing Address
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Address Line | 600 IVY ST STE 206
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City | ELMIRA
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State | NY
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Zip | 14905-1627
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Country | US
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Telephone | 607-271-2050
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Fax | 607-271-2071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 311092
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License Number State | NY
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