Provider Demographics
NPI:1063661940
Name:SMALLEY, MARY JANE (CPNP)
Entity Type:Individual
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First Name:MARY JANE
Middle Name:
Last Name:SMALLEY
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Gender:F
Credentials:CPNP
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Mailing Address - Street 1:P O BOX 8500
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN LOCKBOX #7642
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8478
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:1645 WEST 8TH STREET
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN ERIE
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5097
Practice Address - Country:US
Practice Address - Phone:800-873-5437
Practice Address - Fax:814-875-8796
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2012-10-08
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Provider Licenses
StateLicense IDTaxonomies
NY382009363LP0200X
PASP009524363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics