Provider Demographics
NPI:1366656290
Name:LONIGRO, MARY JO (NP)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:LONIGRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-8242
Mailing Address - Country:US
Mailing Address - Phone:339-927-1014
Mailing Address - Fax:781-846-7687
Practice Address - Street 1:45 PADDOCK WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-8242
Practice Address - Country:US
Practice Address - Phone:339-927-1014
Practice Address - Fax:781-846-7687
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP48447Medicare UPIN