Provider Demographics
NPI:1093792160
Name:WEBSTER, MARYANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-0518
Mailing Address - Country:US
Mailing Address - Phone:860-653-4526
Mailing Address - Fax:860-653-5209
Practice Address - Street 1:13 CHURCH RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-0518
Practice Address - Country:US
Practice Address - Phone:860-653-4526
Practice Address - Fax:860-653-5209
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
002372OtherCT
400002372CT01OtherBCBS
2V3764OtherHEALTHNET
500000468Medicare ID - Type Unspecified
2V3764OtherHEALTHNET