Provider Demographics
NPI:1174677694
Name:MEEKER, MARY C (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:MEEKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 BLACK HAW CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3250
Mailing Address - Country:US
Mailing Address - Phone:301-663-0721
Mailing Address - Fax:
Practice Address - Street 1:11800 TECH RD
Practice Address - Street 2:SUITE#240
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1987
Practice Address - Country:US
Practice Address - Phone:301-754-7740
Practice Address - Fax:301-754-7743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR071879363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021512P80Medicare PIN