Provider Demographics
NPI:1841392461
Name:AUSTIN, MARY KORTH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KORTH
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VAN DUYNE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-5513
Mailing Address - Country:US
Mailing Address - Phone:315-253-0489
Mailing Address - Fax:
Practice Address - Street 1:7445 COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-8216
Practice Address - Country:US
Practice Address - Phone:315-253-1028
Practice Address - Fax:315-253-1309
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse