Provider Demographics
NPI:1366687634
Name:DARRAGH, MARY MARLENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARLENE
Last Name:DARRAGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:MARLENE
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 ALABAMA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-1002
Mailing Address - Country:US
Mailing Address - Phone:501-983-9601
Mailing Address - Fax:
Practice Address - Street 1:123 ALABAMA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1002
Practice Address - Country:US
Practice Address - Phone:501-983-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR82120163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management