Individual
AUDREY A MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4103 MEDICAL CENTER DR, FAYETTEVILLE, NY 13066-6600
(315) 637-7800
(315) 637-7808
Mailing address
4103 MEDICAL CENTER DR, FAYETTEVILLE, NY 13066-6600
(315) 637-7800
(315) 637-7808
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
320426
NY
363LF0000X
Family Nurse Practitioner
Primary
F332143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02119060
—
NY
Enumeration date
05/23/2005
Last updated
11/22/2011
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