Provider Demographics
NPI:1093781551
Name:AMES-CONNOR, MARY M (CRNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:AMES-CONNOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10925
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850-0925
Mailing Address - Country:US
Mailing Address - Phone:888-733-7271
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-674-4700
Practice Address - Fax:302-733-0854
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL6-0A00425367500000X
DEL1-0014709163W00000X
NJ26NR05582900163W00000X
PARN334186L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
47027OtherAANA
DEP00615644OtherRAILROAD MEDICARE
S60120Medicare UPIN
DEP00615644OtherRAILROAD MEDICARE