Provider Demographics
NPI:1285843508
Name:RODRIGUEZ, MARY MARGARET (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E. 13TH ST.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-2140
Mailing Address - Country:US
Mailing Address - Phone:520-225-3017
Mailing Address - Fax:520-225-3001
Practice Address - Street 1:2035 S HOWARD STRA
Practice Address - Street 2:200 E. 13TH ST.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-1442
Practice Address - Country:US
Practice Address - Phone:520-225-3017
Practice Address - Fax:520-225-3001
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN22103163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ573396Medicaid