Provider Demographics
NPI:1104836576
Name:NAIRN, MARY THERESE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:NAIRN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 WRANGLER RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3709
Mailing Address - Country:US
Mailing Address - Phone:302-738-4985
Mailing Address - Fax:302-633-5339
Practice Address - Street 1:1601 KIRKWOOD HWY
Practice Address - Street 2:WOMENS HEALTH CLINIC
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4917
Practice Address - Country:US
Practice Address - Phone:302-994-2511
Practice Address - Fax:302-633-5339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000128363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3029OtherPRESCRIPTIVE#RXAPN