Provider Demographics
NPI:1174261374
Name:MCMAHON, MARY (DNP, FNP-BC, CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:DNP, FNP-BC, CRNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:FRATTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1337 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4439
Mailing Address - Country:US
Mailing Address - Phone:724-953-4889
Mailing Address - Fax:
Practice Address - Street 1:555 PA-217
Practice Address - Street 2:#1
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-694-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP025695OtherLICENSE NUMBER