Individual
DARYL LYNN MAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
128 NORTON RD, SANDY CREEK, NY 13145-3177
(315) 387-3235
Mailing address
128 NORTON RD, SANDY CREEK, NY 13145-3177
(315) 387-3235
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
276590-1
NY
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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