MEDICARE: MRS. MARY R. CONTANT RN, BSN

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	163W00000X	Registered Nurse	244189-1	NY

General Provider Information

NPI Number	:	1225358674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY R. CONTANT RN, BSN

Provider Business Mailing Address
First Line	:	13 CHURCH ST
Second Line	:	P.O. BOX 66
City	:	ELBA
State	:	NY
Zip	:	14058-9765
Country	:	US
Telephone Number	:	585-757-9927
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 CHURCH ST
Second Line	:
City	:	ELBA
State	:	NY
Zip	:	14058-9765
Country	:	US
Telephone Number	:	585-757-9927
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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