Provider Demographics
NPI:1255664280
Name:CORGAN, MARY ELIZABETH (MSN APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CORGAN
Suffix:
Gender:F
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5761
Mailing Address - Country:US
Mailing Address - Phone:573-334-6008
Mailing Address - Fax:573-334-1713
Practice Address - Street 1:371 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5761
Practice Address - Country:US
Practice Address - Phone:573-334-6008
Practice Address - Fax:573-334-1713
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO125183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily