Individual
MRS. AUDREY RAE MAYETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
3348 LISK RD, ODESSA, NY 14869-9761
(607) 594-4883
Mailing address
3348 LISK RD, ODESSA, NY 14869-9761
(607) 594-4883
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
276768-1
NY
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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