Provider Demographics
NPI:1043567027
Name:SALLY WEARE EDNEY, INC
Entity Type:Organization
Organization Name:SALLY WEARE EDNEY, INC
Other - Org Name:SALLY WEARE EDNEY CHILDREN'S HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:HALLMARK
Authorized Official - Suffix:
Authorized Official - Credentials:CMM, CCO
Authorized Official - Phone:775-742-7028
Mailing Address - Street 1:730 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1304
Mailing Address - Country:US
Mailing Address - Phone:775-870-1000
Mailing Address - Fax:775-870-1003
Practice Address - Street 1:730 WILLOW ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1304
Practice Address - Country:US
Practice Address - Phone:775-870-1000
Practice Address - Fax:775-870-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00284363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty