Provider Demographics
NPI:1114180510
Name:BEAN, MARY ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BEAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 ROUTE 80
Mailing Address - Street 2:BOX 1116
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-1116
Mailing Address - Country:US
Mailing Address - Phone:315-696-6114
Mailing Address - Fax:315-696-8509
Practice Address - Street 1:5821 ROUTE 80
Practice Address - Street 2:BOX 1116
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159-1116
Practice Address - Country:US
Practice Address - Phone:315-696-6114
Practice Address - Fax:315-696-8509
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333539-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily