Provider Demographics
NPI:1417958711
Name:MCGUIRE, MARY ANN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W 2ND ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-2000
Mailing Address - Country:US
Mailing Address - Phone:575-627-1200
Mailing Address - Fax:888-445-1844
Practice Address - Street 1:1627 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-2656
Practice Address - Country:US
Practice Address - Phone:575-208-0106
Practice Address - Fax:575-208-0700
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR38408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR6548Medicaid
NM79619OtherPRESBYTERIAN
MARYANNMCGUIREOtherTRICARE
110162385OtherRR MEDICARE
87726OtherUNITED HEALTH CARE
841627609OtherHEALTHSMART
NMNM011928OtherBCBS
NMR6548Medicaid
A53569Medicare UPIN
NMNM011928OtherBCBS