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NPI Code Detail

MEDICARE: MARY ELIZABETH BEAN FNP

MEDICARE:   MARY ELIZABETH BEAN  FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF333539-1NY

General Provider Information

NPI Number : 1114180510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH BEAN FNP
Provider Business Mailing Address
First Line : 5821 ROUTE 80
Second Line : BOX 1116
City : TULLY
State : NY
Zip : 13159-1116
Country : US
Telephone Number : 315-696-6114
Fax Number : 315-696-8509
Provider Business Practice Location Address
First Line : 5821 ROUTE 80
Second Line : BOX 1116
City : TULLY
State : NY
Zip : 13159-1116
Country : US
Telephone Number : 315-696-6114
Fax Number : 315-696-8509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2008
Last Update Date : 07/07/2008

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Directions to “ MARY ELIZABETH BEAN FNP” Practice Location

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