Provider Demographics
NPI:1144201708
Name:MARRS, MARY ANN (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MARRS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 S HIGHWAY 16
Mailing Address - Street 2:PO BOX 6850
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8708
Mailing Address - Country:US
Mailing Address - Phone:605-341-1414
Mailing Address - Fax:605-341-7062
Practice Address - Street 1:7220 S HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8708
Practice Address - Country:US
Practice Address - Phone:605-341-1414
Practice Address - Fax:605-341-7062
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR029403363LF0000X
SDSD-CNP CP000412364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00427538OtherMEDICARE RAILROAD PTAN
SD1254560001OtherCIGNA MEDICARE
SD6827452Medicaid
P00427538OtherMEDICARE RAILROAD PTAN