MEDICARE: MARY BETH FRARY-PELLETIERI RN

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	385367-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841490604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH FRARY-PELLETIERI RN

Provider Business Mailing Address
First Line	:	13 CENTER ST
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-2408
Country	:	US
Telephone Number	:	518-891-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 CENTER ST
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-2408
Country	:	US
Telephone Number	:	518-891-4148
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/20/2007

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