Provider Demographics
NPI:1336128818
Name:MCGARY, MAUREEN L (MSN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:L
Last Name:MCGARY
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WIRTZ
Mailing Address - State:VA
Mailing Address - Zip Code:24184-4270
Mailing Address - Country:US
Mailing Address - Phone:540-721-3319
Mailing Address - Fax:
Practice Address - Street 1:390 S MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1711
Practice Address - Country:US
Practice Address - Phone:540-484-4855
Practice Address - Fax:540-484-4865
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001065202163W00000X
VA0024-166101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010372682Medicaid
Q47870Medicare UPIN
009105C02Medicare ID - Type Unspecified
011811C21Medicare PIN
VA009105C02Medicare PIN