Provider Demographics
NPI:1568554525
Name:MAMER, MARY C (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:MAMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 SW CHAD DRIVE
Mailing Address - Street 2:PO BOX 2066
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394
Mailing Address - Country:US
Mailing Address - Phone:541-961-8805
Mailing Address - Fax:541-563-6974
Practice Address - Street 1:1255 SW CHAD DRIVE
Practice Address - Street 2:# 2066
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-2066
Practice Address - Country:US
Practice Address - Phone:541-961-8805
Practice Address - Fax:541-563-6974
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098279Medicaid