Provider Demographics
NPI:1184076457
Name:CARSON, MARY VERONICA (MS, FNP-C, CHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:VERONICA
Last Name:CARSON
Suffix:
Gender:F
Credentials:MS, FNP-C, CHNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:VERONICA
Other - Last Name:STONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:601 ELMWOOD AVE # 670
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-1900
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-5647
Practice Address - Country:US
Practice Address - Phone:585-273-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320093363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner