Maryellen Hanley, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

298356-01 Issued in NY

Practice address

3127 King St
Endwell, NY 13760-3369

Phone

(607) 752-4701

NPI assigned

Apr 26, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1740924760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3127 KING ST",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137603369",
            "telephone_number": "607-752-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3127 KING ST",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137603369",
            "telephone_number": "607-752-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "MARYELLEN",
        "name_prefix": "Miss",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-26",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "298356-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NY-7006774",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Shepherd Village at Endwell, Inc.
• Amy Guiles, LMSW
• Karen J Guillon, SPECIAL ED TEACHER
• Kaitlyn Marie Gustafson
• Hanger Medical LLC
• Iesa Marie Harrigan, MS, CRC, LMHC
• Jonathan A Harris, MD
• Sally Hartwick, MD
• Patrizia Haus, LCSW
• Courtney Lynn Hayes, LMSW

• All providers in Endwell, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.