Provider Demographics
NPI:1326665142
Name:TODD, MARY ANN (AGNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:TODD
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BILTMORE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-5017
Mailing Address - Country:US
Mailing Address - Phone:910-719-3666
Mailing Address - Fax:
Practice Address - Street 1:125 BILTMORE DR STE 1
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5017
Practice Address - Country:US
Practice Address - Phone:910-719-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014125363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health