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NPI Code Detail

MEDICARE: HOLLY ELLEN MAULT ANP, FNP

MEDICARE: HOLLY ELLEN MAULT ANP, 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
1363LA2200XAdult Health Nurse Practitioner304327NY
2363LF0000XFamily Nurse Practitioner337423NY

General Provider Information

NPI Number : 1659469310
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY ELLEN MAULT ANP, FNP
Provider Business Mailing Address
First Line : 347 LAKE SHORE DR
Second Line :
City : MONROE
State : NY
Zip : 10950-1814
Country : US
Telephone Number : 845-782-6298
Fax Number :
Provider Business Practice Location Address
First Line : 45 FOSTER RD
Second Line :
City : HOPEWELL JUNCTION
State : NY
Zip : 12533-6123
Country : US
Telephone Number : 845-226-4590
Fax Number : 845-226-2465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 10/30/2013

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