MEDICARE: MARY ELY N.P.

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
1	363L00000X	Nurse Practitioner	277000332	IL

General Provider Information

NPI Number	:	1225074495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELY N.P.

Provider Business Mailing Address
First Line	:	300 SATTLEY ST
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9241
Country	:	US
Telephone Number	:	217-789-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SATTLEY ST
Second Line	:
City	:	ROCHESTER
State	:	IL
Zip	:	62563-9241
Country	:	US
Telephone Number	:	217-789-3630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/29/2021

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Directions to “ MARY ELY N.P.” Practice Location

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