MEDICARE: MRS. MAUREEN WYETH LPN

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	164W00000X	Licensed Practical Nurse		NJ

General Provider Information

NPI Number	:	1225151673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN WYETH LPN

Provider Business Mailing Address
First Line	:	18 MIMOSA DRIVE
Second Line	:
City	:	NORTH CAPE MAY
State	:	NJ
Zip	:	08204
Country	:	US
Telephone Number	:	609-408-1662
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 MIMOSA DR
Second Line	:
City	:	NORTH CAPE MAY
State	:	NJ
Zip	:	08204-3524
Country	:	US
Telephone Number	:	609-408-1662
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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