Provider Demographics
NPI:1558649244
Name:SCHAEFER, MARY ELLEN (ANP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MILLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5613
Mailing Address - Country:US
Mailing Address - Phone:631-374-0534
Mailing Address - Fax:
Practice Address - Street 1:4 MILLSTONE DR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5613
Practice Address - Country:US
Practice Address - Phone:631-374-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305771363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health