Provider Demographics
NPI:1447793211
Name:LLARENA, MARY KATHERINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY KATHERINE
Middle Name:
Last Name:LLARENA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E MAIN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4825
Mailing Address - Country:US
Mailing Address - Phone:805-928-0610
Mailing Address - Fax:805-928-0680
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-928-0610
Practice Address - Fax:805-928-0680
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005344363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty