Provider Demographics
NPI:1437248119
Name:AGNEW, MARY C (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:AGNEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 MARTHAS LN
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-3397
Mailing Address - Country:US
Mailing Address - Phone:508-432-1718
Mailing Address - Fax:
Practice Address - Street 1:19 HENRY ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1714
Practice Address - Country:US
Practice Address - Phone:781-562-0468
Practice Address - Fax:781-574-3926
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP57062Medicare UPIN