Provider Demographics
NPI:1336416247
Name:HUGHES, MARY ELIZABETH (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HUGHES
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 1:4680 FAIRBANKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:13215
Mailing Address - Country:UM
Mailing Address - Phone:315-382-0488
Mailing Address - Fax:
Practice Address - Street 1:4680 FAIRBANKS DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9501
Practice Address - Country:US
Practice Address - Phone:315-382-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347235-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse