Provider Demographics
NPI:1073590964
Name:AMES, MARY (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44855-9602
Mailing Address - Country:US
Mailing Address - Phone:419-744-2249
Mailing Address - Fax:
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:44855-9602
Practice Address - Country:US
Practice Address - Phone:419-744-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2603098Medicaid
OH2603098Medicaid
OHNP19361Medicare PIN