Provider Demographics
NPI:1417953092
Name:DUMAS, MARY ANNE (PHD, RN, CFNP, FAANP)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:
Last Name:DUMAS
Suffix:
Gender:F
Credentials:PHD, RN, CFNP, FAANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2945
Mailing Address - Country:US
Mailing Address - Phone:631-271-2178
Mailing Address - Fax:631-692-0956
Practice Address - Street 1:NURSE PRACTITIONER
Practice Address - Street 2:YELLOW PRIMARY CARE CLINIC, VAMC, 76 MIDDLEVILLE ROAD
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330557-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily