Provider Demographics
NPI:1164446035
Name:MANN, MARY NEUSCH (GNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NEUSCH
Last Name:MANN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 LAVACA ST
Mailing Address - Street 2:SUITE 110-320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2172
Mailing Address - Country:US
Mailing Address - Phone:512-477-4088
Mailing Address - Fax:512-482-0390
Practice Address - Street 1:1108 LAVACA ST
Practice Address - Street 2:SUITE 110-320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2172
Practice Address - Country:US
Practice Address - Phone:512-477-4088
Practice Address - Fax:512-482-0390
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534263363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7511OtherBCBS TEXAS
TXP00230208OtherMEDICARE RAILROAD
TX141124102Medicaid
TXP00230208OtherMEDICARE RAILROAD
TX141124102Medicaid