Provider Demographics
NPI:1275670523
Name:BARANIK, MARY ELLEN (CFNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BARANIK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:31 SEYMOUR ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5521
Mailing Address - Country:US
Mailing Address - Phone:860-972-0475
Mailing Address - Fax:
Practice Address - Street 1:31 SEYMOUR ST FL 2
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5521
Practice Address - Country:US
Practice Address - Phone:860-972-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47075363LF0000X
CT7462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7101133000Medicaid
OH2351600Medicaid
WV000597734OtherBCBS
WVNP12841Medicare ID - Type Unspecified
WV7101133000Medicaid