Provider Demographics
NPI:1396023180
Name:MAINE, KATHYRON ANN (MS, ANP)
Entity type:Individual
Prefix:
First Name:KATHYRON
Middle Name:ANN
Last Name:MAINE
Suffix:
Gender:F
Credentials:MS, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LODER ST
Mailing Address - Street 2:STE A
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1950
Mailing Address - Country:US
Mailing Address - Phone:607-324-5404
Mailing Address - Fax:607-324-5463
Practice Address - Street 1:111 LODER ST
Practice Address - Street 2:STE A
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1950
Practice Address - Country:US
Practice Address - Phone:607-324-5404
Practice Address - Fax:607-324-5463
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305821363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health