Provider Demographics
NPI:1548598808
Name:MCGRORY, MARTHA MARIE (MAN, RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MARIE
Last Name:MCGRORY
Suffix:
Gender:F
Credentials:MAN, RN, CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-291-2848
Mailing Address - Fax:
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-291-2848
Practice Address - Fax:651-312-3188
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 109383 8363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics