Provider Demographics
NPI:1477523728
Name:MCNERNEY, EDWARD MARTIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARTIN
Last Name:MCNERNEY
Suffix:
Gender:M
Credentials:PA-C
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 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:
Practice Address - Street 1:626 TAFT STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NM
Practice Address - Zip Code:88029-0690
Practice Address - Country:US
Practice Address - Phone:575-531-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant