Provider Demographics
NPI:1467561597
Name:WELLHONER, MARY F (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:WELLHONER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:645 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-352-9355
Mailing Address - Fax:775-352-3575
Practice Address - Street 1:645 SIERRA ROSE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-352-9355
Practice Address - Fax:775-352-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8741207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016598Medicaid
NVF33988Medicare UPIN
NVV31438Medicare ID - Type Unspecified