Provider Demographics
NPI:1477014827
Name:FORAN, MARY E (APRN; FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:FORAN
Suffix:
Gender:F
Credentials:APRN; FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-2457
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:301 MED TECH PKWY STE 120
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2631
Practice Address - Country:US
Practice Address - Phone:423-794-5590
Practice Address - Fax:423-794-5877
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily