Provider Demographics
NPI:1982981858
Name:D'ENTREMONT, MARY ELIZABETH (ANP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:D'ENTREMONT
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:557 BROADWAY
Mailing Address - Street 2:SCHOLASTIC WELLNESS CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3962
Mailing Address - Country:US
Mailing Address - Phone:212-343-4920
Mailing Address - Fax:
Practice Address - Street 1:557 BROADWAY
Practice Address - Street 2:SCHOLASTIC WELLNESS CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3962
Practice Address - Country:US
Practice Address - Phone:212-343-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305439-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health