Provider Demographics
NPI:1568451383
Name:ANKER, MARY NELL (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NELL
Last Name:ANKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9157
Mailing Address - Country:US
Mailing Address - Phone:541-347-2313
Mailing Address - Fax:541-347-2015
Practice Address - Street 1:110 10TH ST SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9157
Practice Address - Country:US
Practice Address - Phone:541-347-2313
Practice Address - Fax:541-347-2015
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950121NP363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR0000WFBTVOtherNBMC GROUP MEDICARE NUMBER
NY01948232Medicaid
OR930635514OtherNBMC GROUP TAX ID FOR BILLING
OR161133OtherNBMC GROUP MEDICAID NUMBER
OR930635514OtherNBMC GROUP TAX ID FOR BILLING
NY01948232Medicaid