Provider Demographics
NPI:1558553677
Name:NEMETH, MARY (C-FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NEMETH
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:NEMETH-PYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4013
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:304-855-1200
Mailing Address - Fax:304-855-1230
Practice Address - Street 1:386 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:CHAMPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-1200
Practice Address - Fax:304-855-1230
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010776Medicaid
WV3810010776Medicaid