Provider Demographics
NPI:1679577274
Name:PAUELS, MARY E (ANP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PAUELS
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:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0008
Mailing Address - Country:US
Mailing Address - Phone:732-615-3900
Mailing Address - Fax:732-615-0865
Practice Address - Street 1:1270 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2014
Practice Address - Country:US
Practice Address - Phone:732-615-3900
Practice Address - Fax:732-615-0865
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07729800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8360201Medicaid
NJ039076DE4OtherMEDICARE
NJ039076DE4OtherMEDICARE