Provider Demographics
NPI:1477790947
Name:FOGARTY, MARY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-952-3400
Mailing Address - Fax:602-952-3401
Practice Address - Street 1:702 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-3529
Practice Address - Country:US
Practice Address - Phone:602-952-3400
Practice Address - Fax:602-952-3401
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN024376163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult