Provider Demographics
NPI:1043392590
Name:BANNON, MARY S (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:BANNON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:47 HIGH STREET SUITE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-685-2460
Mailing Address - Fax:978-685-2572
Practice Address - Street 1:671 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0602
Practice Address - Country:US
Practice Address - Phone:781-647-3040
Practice Address - Fax:781-647-3044
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA158347363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology