Provider Demographics
NPI:1427033679
Name:SWEENEY, MARY ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:SWEENEY
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 1:9415 WORKBENCH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1648
Mailing Address - Country:US
Mailing Address - Phone:314-775-9042
Mailing Address - Fax:
Practice Address - Street 1:4352 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2138
Practice Address - Country:US
Practice Address - Phone:314-531-5444
Practice Address - Fax:314-531-0063
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000080603OtherCPIN
MO429990401Medicaid
MO429990401Medicaid